Standing with assistance of a tilt table in intensive care: A survey of Australian physiotherapy practice

Abstract

Although tilt tables are used by physiotherapists to reintroduce patients to the vertical position, no quantitative evidence is available regarding their use within intensive care units (ICUs) of Australian hospitals. The purpose of this study was to evaluate the use of tilt tables in physiotherapy management of patients in ICUs across Australia. Ninety-nine physiotherapists working in Australian public ICUs were contacted via mail and asked to complete a questionnaire regarding their use of tilt tables in practice. Reasons for the use of the tilt table, contraindications, commonly used adjuncts, monitoring, and outcome measures were also investigated. Eighty-six questionnaires were returned (87% response). The tilt table was used by 58 physiotherapists (67.4%). The most common reasons for inclusion of tilt table treatment were to: facilitate weight bearing (94.8% of those who tilt); prevent muscle contractures (86%); improve lower limb strength (81%); and increase arousal (70%). The tilt table was most frequently applied to patients with neurological conditions (63.8%) and during long-term ICU stay (43.1%). Techniques often combined with tilt table treatment included upper limb exercises (93.1%) and breathing exercises (86.2%). Standing with assistance of the tilt table is used by the majority of physiotherapists working in Australian ICUs. A moderate level of agreement is demonstrated by physiotherapists regarding indications to commence tilt table treatment and adjunct modalities combined with standing with assistance of the tilt table.

Usual Care Physiotherapy During Acute Hospitalization in Subjects Admitted to the ICU: An Observational Cohort Study

“…Following acute hospital discharge, 36% returned home without additional support, 30% returned with home-care support, 22% were discharged to in-patient rehabilitation, 8% were transferred to other hospitals, and 4% were transferred to other destinations. The median (IQR) number of treatment entries per subject was 5 (3-9) in the ICU (median ICU stay of 4.3 [3][4][5][6][7] d) and 6 (2-12) on the acute wards (median ward stay of 13.3 [6 -28] d). Documented physiotherapy treatment provision in the ICU and on the wards is presented in Figure 2.…”

“…[1][2][3][4] Historically, physiotherapists in Australia and New Zealand have provided modalities of treatment in 2 broad categories in the ICU, rehabilitation and respiratory therapy (or chest physiotherapy), 5,6 with the majority of physiotherapists self-reporting the provision of respiratory care activities in Australia, 7,8 Europe, 9 and India. 10 In contrast, in North America, rehabilitation and respiratory therapy/chest physiotherapy techniques are attributable to physical therapists and respiratory therapists, respectively, and chest physiotherapy is less likely to be used by physical therapists in the ICU.…”

“…11 There has been difficulty in developing a clear international consensus on the physiotherapists' role and standardization of task performance, 12,13 although the role of physiotherapy within the ICU is well-established. 5,14,15 Few studies have collected empirical data on the frequency of exposure to physiotherapy intervention in the ICU, which has led to a historical reliance on the use of self-reported national practice surveys [7][8][9][10][11][16][17][18][19][20][21][22][23] and anecdotal experience or expert opinion to define and describe the role of physiotherapy. Considerable variation in critical care physiotherapy practice is an important and potentially undesirable consequence.…”

A Five-day Orthostatic Training Program Improves Cardiovascular Response in Intensive Care Patients

“…Possible consequences include; decrease in total blood volume, increase in heart rate (HR) at rest, orthostatic intolerance, probability of thromboembolism, atelectasis, pleural effusion, failure in mechanical ventilation weaning, oxygen desaturation, predisposition to pneumonia, decrease in muscles' strength, bone loss, loss in the vestibular system accuracy, excess morbidity and mortality, and increase of length of stay and of costs involved with hospitalization [3][4][5].…”

“…Early introduction of rehabilitation interventions [5] reduces clinical complications and length of stay, and improves self-esteem and quality of life of critical patients [6,7], as it minimizes the impact of immobilization [8].…”