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A. Newman1,2, M.E. Kho2,3, J.E. Harris2, A. Fox-Robichaud1,4, P. Solomon2
1Hamilton Health Sciences, Critical Care, Hamilton, Canada, 2McMaster University, School of Rehabilitation Science, Hamilton, Canada, 3St. Joseph's Healthcare Hamilton, Physiotherapy, Hamilton, Canada, 4McMaster University, Medicine, Hamilton, Canada
Background: Cardiac surgery is commonly performed worldwide. Most patients are admitted to an intensive care unit (ICU) post-operatively and receive physiotherapy. Due to improvements in non-invasive cardiac revascularization, patients undergoing cardiac surgery are older and have more comorbidities. This leads to increased risk of developing a post-operative critical illness. Early mobilization of critically ill patients is one means of reducing the iatrogenic effects of prolonged ICU admissions. In-bed cycling is a relatively novel rehabilitation modality that allows critical care physiotherapists to initiate physical rehabilitation earlier in a patient’s recovery. To effectively introduce new treatment modalities an intervention needs to be perceived as both acceptable and feasible to all team members. The experiences of clinicians assisting with cycling implementation has yet to be adequately studied.
Purpose: The purpose of this study was to explore clinicians’ experiences and impressions of their involvement with in-bed cycling in the cardiac surgical ICU as a method of early initiation of rehabilitation with the critically ill cardiac surgery population. Specifically, we examined
(1) whether this intervention was acceptable and
(2) explored the perceived barriers and facilitators to its implementation.
(1) whether this intervention was acceptable and
(2) explored the perceived barriers and facilitators to its implementation.
Methods: We selected an interpretive description methodology to guide our research. Using purposeful, non-probability sampling, all frontline critical care clinicians from various backgrounds who had been present for at least 2 in-bed cycling sessions were eligible for inclusion. Data were collected using semi-structured, face-to-face interviews. Interviews were audio-recorded and transcribed verbatim. Content analytic techniques were used to identify themes and sub-themes.
Results: Nine clinicians (3 registered nurses, 2 physiotherapists, 1 respiratory therapist, 1 nurse educator, 1 physician assistant, and 1 physician) were interviewed. Our sample was predominantly female (77.8%) with a median [IQR] age of 40 years. Critical care experience ranged from less than 5 years to over 30 years. Acceptability of the intervention was influenced by previous cycling experiences, identifying the “ideal” patient, and by understanding how to best time the implementation with the patient’s recovery trajectory. Facilitators to implementation included establishing relationships among team members and with patient’s families, believing that in bed cycling optimizes recovery, striving towards a common team goal, and feeling confident in the method. Barriers that impeded in-bed cycling included inadequate nursing and physiotherapy staffing, misconceptions surrounding compatible medical devices (e.g. femoral catheters), ergometer size, and the time-consuming nature of cycling set-up and delivery.
Conclusion(s): This is the first qualitative study to interview critical care clinicians about their perceptions and experiences with in-bed cycling with adult critically ill patients post cardiac surgery. While clinicians supported the use of in-bed cycling, concerns were identified by participants with respect to appropriate patient selection and proper timing of the intervention. The importance of teamwork within a critical care environment was integral to successful cycling.
Implications: Strategies to overcome the identified barriers may assist with successful cycling implementation in other cardiac surgery critical care environments. Future knowledge translation research should focus on how to best change practice of bedside critical care clinicians using evidence-based strategies.
Funding, acknowledgements: This work was generously supported by the Hamilton Health Sciences Foundation.
Keywords: Critical Care, Cardiac Surgery, Physiotherapy
Topic: Cardiorespiratory
Did this work require ethics approval? Yes
Institution: Hamilton Health Sciences
Committee: Hamilton Integrated Research Ethics Board
Ethics number: 5994
All authors, affiliations and abstracts have been published as submitted.
