PHYSICAL THERAPY IN THE INTENSIVE CARE UNIT: A COMPARATIVE STUDY OF THREE ASIAN COUNTRIES

M.A. Viloria^1,2, Y.-J. Cheng², T. Takahashi³

¹Mariano Marcos State University, Department of Physical Therapy - College of Health Sciences, Batac City, Philippines, ²China Medical University, Department of Physical Therapy - Graduate Institute of Rehabilitation Science, Taichung City, Taiwan, ³Juntendo University, Department of Physiotherapy - Faculty of Health and Medical Sciences, Tokyo, Japan

Background: Physical therapy (PT) is proven beneficial among critically ill patients. However, there is an extent to the practice of PT in the intensive care unit (ICU) which differ between countries.

Purpose: The extent of PT practice in the ICU in three Asian countries, namely Japan (JP), Philippines (PH), and Taiwan (TW), was determined and compared by specifically determining the socio-demographic and ICU-related profile of physical therapists (PTs) who have worked in the ICU.

Methods: The study utilized a two-part, semi-structured, nationwide online survey among ICU PTs in JP, PH, and TW. Invitation letters (with attached flyer) to participate in the study were sent via e-mail to hospitals and/or PT organizations and posted on social media platforms. Descriptive analysis used frequency, mean, and percentages to present the different variables. Pearson Chi-square, Fisher’s Exact test, and One-way ANOVA were used to compare different variables between countries. The level of significance was set atp< 0.05.

Results: One hundred sixty-four PTs (JP=76; PH=45; TW=43) participated in the online survey. Significant differences in all socio-demographic variables(p<0.05)and in the following ICU-related profile of PTs were noted between countries – ICU work experience, duration of ICU posting, ICU stay per day, on-call ICU PT service engagement, source of ICU patient referral, PT-patient ratio, and participation in an ICU-related PT training (all withp<0.05).Medical, surgical, and neurologic ICUs are the most common ICUs where JP, PH, and TW PTs work, but more in surgical and neurologic ICUs which also showed significant differences between countries(both with p<0.05). On the other hand, no significant differences were noted in the hiring department, status of posting, ICU PT ratio in the hospital, and the number of daily ICU patients(all with p>0.05). Standard PT techniques in the ICU in the three countries were passive and active-assisted ROM, positioning, and breathing but yielded significant differences (all with p<0.05), with passive ROM and positioning more implemented in PH, active-assisted ROM in TW, and sitting balance-tolerance in JP. The most common challenge faced in ICU PT service delivery in JP, PH, and TW is“little to no training prior to ICU duty,”showing no significant difference between the three countries under study (p=0.333).

Conclusions: Given the different health systems that JP, PH, and TW have, ICU PT is practiced differently up to some extent between the three countries. Remarkably, differences in the PT interventions implemented and challenges in ICU PT service delivery were also evident.

Implications: This study could serve as a guide to enhance existing policies and to address the challenges faced in the practice of PT in the ICU.

Funding acknowledgements: MOST 110-2410-H-039-010-

Keywords:
Physical therapy practice
Intensive care unit
ICU Physical therapy

Topics:
Professional practice: other
Professional issues
Service delivery/emerging roles

Did this work require ethics approval? Yes

Institution: China Medical University Hospital; Juntendo University

Committee: Ethics Review Board; Faculty of Health Sciences Research Ethics Committee

Ethics number: CMUH110-REC1-192; 00013