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Aranis N1,2, Merino-Osorio C1
1Universidad del Desarrollo, School of Physical Therapy, Santiago, Chile, 2Clínica Alemana de Santiago, Servicio de Medicina Física y Rehabilitación, Santiago, Chile
Background: The physiotherapist (PT) is an integral component of the multidisciplinary management of critical patients, contributing to reduce the length of stay in Intensive Care Unit (ICU), and reducing mortality in a 15% when PT-availability is 24-hours a day and 7-days a week (24/7). In other health professions, the workload has been associated with the risk of death in ICU patients, increasing by 3.5 (95%CI, 1.3-9.1) when the patient-to-nurse ratio is greater than 2.5, and increasing by 2.0 (95%CI, 1.3-3.2) when the patient-to-physician ratio exceeds 14 patients. PT-availability, workload and professional training could be determinant in the outcome of the patients within the ICU, however, it is not known if these factors are considered at the moment of establishing the physiotherapeutic recommendations for the function of adult ICUs.
Purpose: To describe the recommendations for PT-availability, workload and professional training in adult ICUs will contribute with knowledge about the minimum physiotherapeutic requirements for adult ICU operation to favor the efficient use of resources in health settings.
Methods: Scoping review in MEDLINE, LILACS, EBSCO and TRIPDATABASE from the inception of databases to July 2017. Additionally, a structured grey literature search and hand search was done. A search strategy with keywords and free terms associated with "Intensive Care Units", "Health Planning Guidelines", "Standard of Care" and "Physical Therapy" was used. Articles published in spanish, english and portuguese were eligible, as well as reporting recommendations on PT-availability, workload (defined as patient-to-physiotherapist ratio) and professional training level in adult ICU. Titles, abstracts, and full-text articles were screened for the selection of relevant articles, subjected to a quality control, excluding (1) references that corresponded to other health professionals or (2) framed in a pediatric or neonatal care.
Results: Eight, out of 665 studies met the inclusion criteria; 7 were statements of Societies of Intensive Care Medicine and 1 was a Ministerial recommendation. The main documents were from America and Europe. It was recommended 24/7 PT-availability by 75% of the documents, whereas 12.5% suggests part-time availability and 12.5% did not report any labor hours. The patient-to-physiotherapist ratio was reported in three articles being 1:12, 1:6 and 1:5 in each one; and five documents did not report this recommendation. Four articles exposed the importance of the specialty level of the PT in the ICU, suggesting that should possess previous knowledge and special training in respiratory care and physical rehabilitation of critical patients.
Conclusion(s): Physiotherapeutic recommendations in the ICU are heterogeneous in content and origin. In Europe, the recommendations are based on a continental organization, while in America are by country. Recommendations from the rest of the world in scientific databases are scarce. The most reported recommendation was the ICU PT-availability.
Implications: This study describes the physiotherapeutic recommendations and identifies a possible gap that could highlight the importance of the human resources and the workload of PT in the ICU. This information should be used to conduct working groups among government organizations that allow the establishment of minimum basic guidelines that can be implemented worldwide.
Keywords: Intensive Care Units, ; Physical Therapy, Scoping Review
Funding acknowledgements: None
Purpose: To describe the recommendations for PT-availability, workload and professional training in adult ICUs will contribute with knowledge about the minimum physiotherapeutic requirements for adult ICU operation to favor the efficient use of resources in health settings.
Methods: Scoping review in MEDLINE, LILACS, EBSCO and TRIPDATABASE from the inception of databases to July 2017. Additionally, a structured grey literature search and hand search was done. A search strategy with keywords and free terms associated with "Intensive Care Units", "Health Planning Guidelines", "Standard of Care" and "Physical Therapy" was used. Articles published in spanish, english and portuguese were eligible, as well as reporting recommendations on PT-availability, workload (defined as patient-to-physiotherapist ratio) and professional training level in adult ICU. Titles, abstracts, and full-text articles were screened for the selection of relevant articles, subjected to a quality control, excluding (1) references that corresponded to other health professionals or (2) framed in a pediatric or neonatal care.
Results: Eight, out of 665 studies met the inclusion criteria; 7 were statements of Societies of Intensive Care Medicine and 1 was a Ministerial recommendation. The main documents were from America and Europe. It was recommended 24/7 PT-availability by 75% of the documents, whereas 12.5% suggests part-time availability and 12.5% did not report any labor hours. The patient-to-physiotherapist ratio was reported in three articles being 1:12, 1:6 and 1:5 in each one; and five documents did not report this recommendation. Four articles exposed the importance of the specialty level of the PT in the ICU, suggesting that should possess previous knowledge and special training in respiratory care and physical rehabilitation of critical patients.
Conclusion(s): Physiotherapeutic recommendations in the ICU are heterogeneous in content and origin. In Europe, the recommendations are based on a continental organization, while in America are by country. Recommendations from the rest of the world in scientific databases are scarce. The most reported recommendation was the ICU PT-availability.
Implications: This study describes the physiotherapeutic recommendations and identifies a possible gap that could highlight the importance of the human resources and the workload of PT in the ICU. This information should be used to conduct working groups among government organizations that allow the establishment of minimum basic guidelines that can be implemented worldwide.
Keywords: Intensive Care Units, ; Physical Therapy, Scoping Review
Funding acknowledgements: None
Topic: Cardiorespiratory
Ethics approval required: No
Institution: Universidad del Desarrollo
Ethics committee: Scientific Ethics Committee Universidad del Desarrollo
Reason not required: This study does not require ethical approval because it contemplates the review of published scientific articles.
All authors, affiliations and abstracts have been published as submitted.
