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

Abstract

Background: Physiotherapists play an important role in the provision of multidisciplinary team-based care in the ICU. No studies have reported usual care respiratory management or usual care on the wards following ICU discharge by these providers. This study aimed to investigate usual care physiotherapy for ICU subjects during acute hospitalization. Methods: One hundred subjects were recruited for an observational study from a tertiary Australian ICU. The frequency and type of documented physiotherapist assessment and treatment were extracted retrospectively from medical records. Results: The sample had median (interquartile range) APACHE II score of 17 (13–21) and was mostly male with a median (interquartile range) age of 61 (49–73) y. Physiotherapists reviewed 94% of subjects in the ICU (median of 5 [3–9] occasions, median stay of 4.3 [3–7] d) and 89% of subjects in acute wards (median of 6 [2–12] occasions, median stay of 13.3 [6–28] d). Positioning, ventilator lung hyperinflation, and suctioning were the most frequently performed respiratory care activities in the ICU. The time from ICU admission until ambulation from the bed with a physiotherapist had a median of 5 (3–8) d. The average ambulation distance per treatment had a median of 0 (0–60) m in the ICU and 44 (8–78) m in the acute wards. Adverse event rates were 3.5% in the ICU and 1.8% on the wards. Conclusions: Subjects received a higher frequency of physiotherapy in the ICU than on acute wards. Consensus is required to ensure consistency in data collection internationally to facilitate comparison of outcomes.