Physiotherapy practice in South African intensive care units

Abstract

Background. Physiotherapists are integral members of the interprofessional team that provides care and rehabilitation for patients in intensive care units (ICUs). Objectives. To describe the current practice of physiotherapists in ICUs, determine if physiotherapists' practice has changed since a previous report and determine if practice is evidence based. Methodology. A questionnaire was content validated and made available electronically and in hard copy. Physiotherapists who work in ICUs in public or private sector hospitals or who are members of the South African Society of Physiotherapy were identified and invited to participate. Results. Survey response rate was 33.9%. Patient assessment techniques performed 'very often' included ICU chart assessment (n=90, 83.3%), chest auscultation (n=94, 81.8%) and cough effort (n=81, 75%). Treatment techniques performed 'very often' included manual chest clearance (n=101, 93.5%), in-bed mobilisation and positioning (n=91, 84.3%; n=91, 84.3%, respectively), airway suctioning (n=89, 82.4%), out-of-bed mobilisation (n=84, 77.8%), deep breathing exercises (n=83, 76.9%) and peripheral muscle-strengthening exercises (n=72, 73.1%). More respondents used intermittent positive pressure breathing (57 v. 28%, p=0.00), used adjustment of mechanical ventilation (MV) settings (30 v. 15%, p=0.01), were involved with weaning patients from MV (42 v. 19%, p=0.00) and used incentive spirometry (76 v. 46%, p=0.00) than reported previously. More respondents performed suctioning (99 v. 70%, p=0.00), extubation (60 v. 25%, p=0.00) and adjustment of MV settings (30 v. 12%, p=0.02) than reported internationally. Conclusion. Physiotherapy practice in ICUs is evidence based. Care focuses largely on mobilisation, exercise therapy and multimodality respiratory therapy.

Public sector physiotherapists’ organisation and profile: Implications for intensive care service

“…While four of the nine provinces reported a 100% response rate, one province had less than a 50% response rate. The survey was specific to the public sector and therefore gives a clear picture of this specific healthcare sector, as other studies have included both the private and public sectors, with a lack of differentiation between the two groups in their findings (Lottering & Van Aswegen 2016 ). The data are a snapshot of the sector at a specific time and could thus change over time.…”

“…Physiotherapists are trained to provide quality care which could improve patient outcomes with minimal cost to the healthcare budget, thereby improving efficiency in the healthcare system (Morris et al 2021 ). However, globally, many variations in the role and practices of physiotherapists in the management of patients in intensive care have been reported (Berney, Haines & Denehy 2012 ; Lottering & Van Aswegen 2016 ; Norrenberg & Vincent 2000 ; Shpata, Kreka & Tani 2021 ). While work has been done internationally and locally to define and standardise the physiotherapy provided in ICU (Hanekom et al 2015 ; Skinner et al 2016 ; Twose, Jones & Cornell 2019 ; Van Aswegen et al 2017 ), it is important to understand the context within which hospital-based physiotherapy departments, who are responsible for providing a service to ICUs in SA, function.…”

Therapy professionals in critical care: A UK wide workforce survey

“…Five profession specific surveys were also developed to capture information regarding AHP's roles. The chief investigator devised the surveys based on previous examples 4,[13][14][15] with each survey containing identical overarching questions. Once developed by the chief investigator, all draft surveys were reviewed and adapted based on feedback from the research group with profession specific surveys being reviewed by relevant professionals.…”

Physiotherapy in the intensive care unit

“…Physiotherapists working in ICU should have the necessary knowledge and skills to understand normal integrated physiology and anatomy and to use clinical reasoning to execute holistic assessments and effective physiotherapy techniques. As we move towards the implementation of minimum standards of physiotherapy practice in SA, the two surveys included in this edition of SAJCC [6,7] provide valuable data on current physiotherapy practice in SA ICUs. The information is valuable as an international benchmark and to determine the training needs of physiotherapists practising in SA units.…”

“…Lottering and Van Aswegen [6] aimed to describe the current practice of physiotherapists in SA ICUs. A strength of their study is that they attempted to survey both state and private units.…”