PASSIVE LIMB MOVEMENTS ARE WIDELY PRACTICED BY INTENSIVE CARE PHYSIOTHERAPISTS IN THE GULF COOPERATION COUNCIL STATES: A PILOT STUDY

G.K. Alaparthi¹, V. Raigangar¹, S. Mohammad¹, A. Alzarooni¹, M. Atef¹, R. Abdulrahman¹, S. Redha¹, A. Rashid¹

Background: Patients who are critically ill in intensive care units (ICUs) decondition hastily due to bed rest, sedation, and mechanical ventilation. This puts them at high risk for neuromuscular problems including weakness, muscle contracture, and joint range of motion. These sequelae may have a long-term impact on restoration of functional activity. Physiotherapists (PTs) are challenged in ICUs to employ preventive and rehabilitative strategies to combat sequelae. One such strategy is use of passive movements, a technique of involuntary movement of body segments through available joint range of motion (ROM) frequently employed despite limited evidence of its effectiveness. Current physiotherapy practice around the use of passive movements by PTs working in ICUs has not been explored in the Gulf Cooperation council (GCC) countries.

Purpose: This study aimed to explore physiotherapy assessment and intervention practices regarding the use of passive movement in the ICUs

Methods: This cross-sectional pilot study surveyed PTs practicing in ICUs for at least one year. Ethical approval was obtained from the Research and Ethics committee at the University of Sharjah. An online questionnaire composed of 42 questions about physiotherapy service provision, physiotherapy assessment and intervention in the ICUs was completed by the PTs. Data were analyzed using Statistical Package for Social Science (SPSS) Software, version 21

Results: A total of 33 physiotherapists completed this pilot study. Only half (56.2%) of the PTs indicated having a “blanket referral” for physiotherapy. Majority of PTs (80.6%) routinely assessed passive limb ROM for all joints (87.5%), however the assessment was by visual estimation (78.1%). This assessment was done two to three times per week (46.9%) and took between 10-15 minutes (68.8%). Maintaining joint ROM (81%) was ranked as the main reason for performing passive limb ROM followed by increasing soft tissue extensibility (17%) with PTs performing between 1 to 3 sets with 10 repetition each (56.3%). Almost half (51.6%) reported that staff other than PTs performed ROM exercises mainly nursing staff.

Conclusion(s): Passive joint ROM is the most frequently used mobilization technique employed by PTs in ICUs and is mostly performed after subjective assessment. Also, passive ROM is frequently done by staff other than PTs. More caution needs to be exercised in the indiscriminate use of passive joint ROM by PTs in the ICUs. Larger studies are recommended in this area to further explore differences.

Implications: Physiotherapy practice in the GCC is still nascent and requires development in many domains. Studies of this nature help to highlight the practices of PTs working in Intensive care units and may inform policy and practice

Funding, acknowledgements: no funding for this project 

Keywords: Intensive care unit, Passive joint range of motion, mobilization

Topic: Critical care

Did this work require ethics approval? Yes

Institution: University of Sharjah

Committee: Research Ethics Committee of the University of Sharjah

Ethics number: 2020