A short, structured skills training course for critical care physiotherapists in a lower-middle income country

Tunpattu, Sanjeewa; Newey, Victoria; Sigera, Chathurani; Silva, Pubudu De; Goonarathna, Amal; Aluthge, Iranga; Thambavita, Pasan; Perera, H. Y. Ranjit; Meegahawatte, Amila; Isaam, Ilhaam; Dondorp, Arjen M.

doi:10.1080/09593985.2018.1423593

Cited by 7 publications

(10 citation statements)

References 22 publications

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“…Innovative approaches to provide sustainable but short-course training to physiotherapists in resource-limited ICUs have already been piloted and experience from these may be of value in designing future interventions in rehabilitation. 31 In addition, hospital-acquired infection is a potentially modifiable risk factor for muscle wasting in patients and efforts should continue to reduce the incidence of infection.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome and muscle wasting in adults with tetanus

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Duoc

Nhat

et al. 2019

Transactions of the Royal Society of Tropical Medicine and Hygiene

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BackgroundIn many countries, in-hospital survival from tetanus is increasing, but long-term outcome is unknown. In high-income settings, critical illness is associated with muscle wasting and poor functional outcome, but there are few data from resource-limited settings. In this study we aimed to assess muscle wasting and long-term functional outcome in adults with tetanus.MethodsIn a prospective observational study involving 80 adults with tetanus, sequential rectus femoris ultrasound measurements were made at admission, 7 days, 14 days and hospital discharge. Functional outcome was assessed at hospital discharge using the Timed Up and Go test, Clinical Frailty Score, Barthel Index and RAND 36-item Short Form Health Survey (SF-36) and 3 and 6 months after discharge using the SF-36 and Barthel Index.ResultsSignificant muscle wasting occurred between hospital admission and discharge (p<0.01), particularly in severe disease, where a median 23.49% (interquartile range 10.01–26.07) reduction in rectus femoris cross-sectional area occurred in those with severe (Ablett grades 3 and 4) disease. Muscle mass at discharge was related to objective and subjective measures of physical and emotional function at discharge and 3 and 6 months after discharge. In patients >70 y of age, functional recovery at 6 months was reduced compared with younger patients. Hospital-acquired infection and age were risk factors for muscle wasting.ConclusionsSignificant muscle wasting during hospitalization occurred in patients with tetanus, the extent of which correlates with functional outcome.

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Section: Discussionmentioning

confidence: 99%

Functional outcome and muscle wasting in adults with tetanus

Trung

Duoc

Nhat

et al. 2019

Transactions of the Royal Society of Tropical Medicine and Hygiene

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“…Rehabilitation was commenced a median (inter quartile range (IQR)) 14 (10)(11)(12)(13)(14)(15)(16)(17)(18) days after admission. All patients were receiving benzodiazepine sedation and had a tracheostomy in situ at programme commencement.…”

Section: Feasibility Evaluationmentioning

confidence: 99%

“…Each patient received a median (IQR) of 26 (23-39) rehabilitation sessions, equating to a median (IQR) 98 (96-100) percent of intended (prescribed) sessions. Sessions were delivered twice daily to patients on almost all scheduled days once the programme had commenced, with prescribed sessions delivered over a median (IQR) of 14 (10)(11)(12)(13)(14)(15)(16)(17)(18) days. A median of 1 (0-1) sessions per patient were not delivered.…”

Section: Feasibility Evaluationmentioning

confidence: 99%

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Feasibility of establishing a rehabilitation programme in a Vietnamese intensive care unit

et al. 2021

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Increasing numbers of people are surviving critical illness throughout the world, but survivorship is associated with long-term disability. In high-income settings physical rehabilitation is commonly employed to counter this and improve outcomes. These utilize highly-trained multidisciplinary teams and are unavailable and unaffordable in most low and middle income countries (LMICs). We aimed to design a sustainable intensive care unit (ICU) rehabilitation program and to evaluate its feasibility in a LMIC setting. In this project patients, care-givers and experts co-designed an innovative rehabilitation programme that can be delivered by non-expert ICU staff and family care-givers in a LMIC. We implemented this programme in adult patient with patients with tetanus at the Hospital for Tropical Diseases, Ho Chi Minh City over a 5-month period, evaluating the programme’s acceptability, enablers and barriers. A 6-phase programme was designed, supported by written and video material. The programme was piloted in total of 30 patients. Rehabilitation was commenced a median 14 (inter quartile range (IQR) 10–18) days after admission. Each patient received a median of 25.5 (IQR 22.8–34.8) rehabilitation sessions out of a median 27 (22.8–35) intended (prescribed) sessions. There were no associated adverse events. Patients and staff found rehabilitation to be beneficial, enhanced relationships between carers, patients and staff and was deemed to be a positive step towards recovery and return to work. The main barrier was staff time. The programme was feasible for patients with tetanus and viewed positively by staff and participants. Staff time was identified as the major barrier to ongoing implementation.

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“…It is vital that these training programmes, as well as covering specific ICU clinical skills also include basic management and organisational aspects of critical care 2. Successful initiatives such as Train-the-Trainer and peer-to-peer programmes have been shown to be successful in LMICs and could be further expanded 29 30…”

Section: What Should Happen Next?mentioning

confidence: 99%