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

Skinner, Elizabeth H; Haines, Kimberley; Berney, Sue; Warrillow, Stephen; Harrold, Megan; Denehy, Linda

doi:10.4187/respcare.04064

Cited by 32 publications

(26 citation statements)

References 54 publications

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“…Patients may undertake activities independently or while being supported by staff or in combination with equipment. The most commonly used equipment were a tilt table [35, 39, 42, 52, 64, 66, 69, 70, 80, 82] and walking aids [24, 36, 38, 75, 103]. Several authors reported that assisting a mechanically ventilated patient to mobilise required support between one to four people [24, 48, 93, 103].…”

Section: Resultsmentioning

confidence: 99%

Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities

et al. 2019

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BackgroundMechanically ventilated patients often develop muscle weakness post-intensive care admission. Current evidence suggests that early mobilisation of these patients can be an effective intervention in improving their outcomes. However, what constitutes early mobilisation in mechanically ventilated patients (EM-MV) remains unclear. We aimed to systematically explore the definitions and activity types of EM-MV in the literature.MethodsWhittemore and Knafl’s framework guided this review. CINAHL, MEDLINE, EMBASE, PsycINFO, ASSIA, and Cochrane Library were searched to capture studies from 2000 to 2018, combined with hand search of grey literature and reference lists of included studies. The Critical Appraisal Skills Programme tools were used to assess the methodological quality of included studies. Data extraction and quality assessment of studies were performed independently by each reviewer before coming together in sub-groups for discussion and agreement. An inductive and data-driven thematic analysis was undertaken on verbatim extracts of EM-MV definitions and activities in included studies.ResultsSeventy-six studies were included from which four major themes were inferred: (1) non-standardised definition, (2) contextual factors, (3) negotiated process and (4) collaboration between patients and staff. The first theme indicates that EM-MV is either not fully defined in studies or when a definition is provided this is not standardised across studies. The remaining themes reflect the diversity of EM-MV activities which depends on patients’ characteristics and ICU settings; the negotiated decision-making process between patients and staff; and their interdependent relationship during the implementation.ConclusionsThis review highlights the absence of an agreed definition and on what constitutes early mobilisation in mechanically ventilated patients. To advance research and practice an agreed and shared definition is a pre-requisite.

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Section: Resultsmentioning

confidence: 99%

Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities

et al. 2019

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“…known (though not, perhaps, by all readers) to be practiced differently internationally (32,33 40% 68% 29% 50% 44% 22% 24% 10% 20% 95% 67% 70% 75% 41% 75% 67% 72% 38% 18% 44% 26% 31% 25% 23% 16% 62% 31% 50% 54% 54% 24% 24% 58% 18% 26% 43% 56% 44% 57% 32% 79% 18% 68% 34% 44% 70% 46% 36% 23% 55% 49% (34)(35)(36)(37)(38). In contrast, multidisciplinary rounds with daily goal communication may be one of the few durable interventions associated with success, spanning mortality and EM (18,22,24,31,39).…”

Section: Original Researchmentioning

confidence: 99%

Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey

Bakhru¹,

et al. 2016

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Rationale: Early mobilization (EM) improves outcomes for mechanically ventilated patients. Variation in structure and organizational characteristics may affect implementation of EM practices.Objectives: We queried intensive care unit (ICU) environment and standardized ICU practices to evaluate organizational characteristics that enable EM practice. Methods:We recruited 151 ICUs in France, 150 in Germany, 150 in the United Kingdom, and 500 in the United States by telephone. Survey domains included respondent characteristics, hospital and ICU characteristics, and ICU practices and protocols. Measurements and Main Results:We surveyed 1,484 ICU leaders and received a 64% response rate (951 ICUs). Eighty-eight percent of respondents were in nursing leadership roles; the remainder were physiotherapists. Surveyed ICUs were predominantly mixed medicalsurgical units (67%), and 27% were medical ICUs. ICU staffing models differed significantly (P , 0.001 each) by country for high-intensity staffing, nurse/patient ratios, and dedicated physiotherapists. ICU practices differed by country, with EM practices present in 40% of French ICUs, 59% of German ICUs, 52% of U.K. ICUs, and 45% of U.S. ICUs. Formal written EM protocols were present in 24%, 30%, 20%, and 30%, respectively, of those countries' ICUs. In multivariate analysis, EM practice was associated with multidisciplinary rounds (odds ratio [OR], 1.77; P = 0.001), setting daily goals for patients (OR, 1.62; P = 0.02), presence of a dedicated physiotherapist (OR, 2.48; P , 0.001), and the ICU's being located in Germany (reference, United States; OR, 2.84; P , 0.001). EM practice was also associated with higher nurse staffing levels (1:1 nurse/patient ratio as a reference; 1:2 nurse/patient ratio OR, 0.59; P = 0.05; 1:3 nurse/patient ratio OR, 0.33; P = 0.005; 1:4 or less nurse/patient ratio OR, 0.37; P = 0.005). Those responding rarely cited ambulation of mechanically ventilated patients, use of a bedside cycle, or neuromuscular electrical stimulation as part of their EM practice. Physical therapy initiation, barriers to EM practice, and EM equipment were highly variable among respondents. Conclusions:International ICU structure and practice is quite heterogeneous, and several factors (multidisciplinary rounds, setting daily goals for patients, presence of a dedicated physiotherapist, country, and nurse/patient staffing ratio) are significantly associated with the practice of EM. Practice and barriers may be far different based upon staffing structure. To achieve successful implementation, whether through trials or quality improvement, ICU staffing and practice patterns must be taken into account.

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“…In comparison with a recent retrospective audit in critical care, lung transplant recipients began to mobilise at a slightly earlier stage (median 2 vs. 3 days) and received more physiotherapy sessions per hospital stay (median 14 vs. 11). The content of physical rehabilitation sessions was comparable (Skinner et al, ). Results from a further acute physical rehabilitation trial suggested patients perform an average of 22 min of mobility and physical rehabilitation per day on the ward (Berney et al, ).…”

Section: Discussionmentioning

confidence: 94%

The timing and extent of acute physiotherapy involvement following lung transplantation: An observational study

Tarrant

Holland

Maitre

et al. 2018

Physiotherapy Res Intl

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Lung transplant recipients spent 21-34% of observed sessions performing physical exercise beginning 48 hr following surgery. Remaining physiotherapist time was spent on assessment, respiratory interventions, education, and patient-specific duties. The use of physiotherapy assistants, structured, progressive exercise programs, and continued workplace innovation may enable a higher percentage of physiotherapist supervised physical exercise in the future.

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

Cited by 32 publications

References 54 publications

Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities

Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities

Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey

The timing and extent of acute physiotherapy involvement following lung transplantation: An observational study

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