File
Battle K.1
1Duke University School of Medicine, Department of Orthopaedic Surgery, Doctor of Physical Therapy Division (DPT), Durham, United States
Background: The World Health Organization has long advocated for community-based rehabilitation in support of the 15 million people living with disability around the world today. However, an acute medical illness or injury that requires hospitalization is a sentinel event that often results in a new or worsened disability. Lack of in-hospital physical rehabilitation is a major contributing factor to hospital-associated functional decline. Thus, physical rehabilitation that begins earlier in the acute setting may present an important opportunity for mitigating disability severity after hospitalization. The body of physical rehabilitation research to support the provision of services in acute care settings in LMICs has not been synthesized.
Purpose: To conduct a mixed-methods systematic review examining current research on physical rehabilitation practices in acute care settings in LMICs to identify the research methodologies used, specific settings and diagnostic samples studied, the interventions provided, healthcare providers who delivered intervention, and outcomes assessed.
Methods: PubMed, CINAHL, and Embase databases were searched from 2001 through 2016. Study selection included randomized controlled (RCT), cohort, and survey studies in English-language peer-reviewed journals that incorporated physical rehabilitation services for adults admitted to acute care hospitals in LMICs. Four authors (KB, AD, HJ, LV) extracted data for study design, participant characteristics, rehabilitation interventions and providers, and outcomes. All authors synthesized results by categorizing data according to study design, diagnostic samples served, interventions examined with summary of outcomes and by specific unit in the hospital setting (intensive care and/or ward).
Results: Of the 6,435 articles identified, 24 studies were included: 10 randomized clinical trials, 6 cohort studies, and 8 surveys across 11 countries. The primary diagnostic sample included in clinical trials was critically ill patients in intensive care (25%). The clinical practice surveys sampled physiotherapists mainly working in intensive care (17%). Thus, the predominant setting represented across all studies was intensive care (42%). A total of 56 different interventions were provided; the 3 most common were suctioning (n=10), huffing/coughing (n=8), and positioning for airway clearance (n=8). Compared with these respiratory-focused interventions, mobility-focused interventions (e.g., bed mobility, transfers, ambulation) were underrepresented. Physiotherapists were the most common rehabilitation provider listed in the clinical trials. Given the heterogeneity of study design, diagnostic samples, rehabilitation protocols, and outcomes, meta-analysis was not possible.
Conclusion(s): Physical Rehabilitation research originating in LMICs and reported in peer-reviewed journals is emerging. Airway clearance interventions delivered by physiotherapists to patients critically ill in intensive care was most commonly detailed. In comparison, the use of mobility-focused interventions was described less often, suggesting an important area for greater research.
Implications: There is a tremendous opportunity to improve the capacity and amount of rigorous physical rehabilitation research in acute care settings in LMICs. Additional research on acute care rehabilitation may direct interventions and support workforce improvements needed to decrease disability early in the care trajectory. These efforts would complement those that are already advocated at the community level. Both strategies are required to bend the curve on the growing number of people with disabilities in LMICs.
Funding acknowledgements: No funding to declare.
Topic: Critical care
Ethics approval: Ethics approval is not required.
All authors, affiliations and abstracts have been published as submitted.
