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Van Aswegen H1, Reeve J2, Fagevik Olsén M3, Beach L4, Parker R5
1University of the Witwatersrand, Physiotherapy, Johannesburg, South Africa, 2Auckland University of Technology, Physiotherapy, Auckland, New Zealand, 3Sahlgrenska University Hospital, Physical Therapy, Göteborg, Sweden, 4The Royal Melbourne Hospital, Physiotherapy, Melbourne, Australia, 5University of Cape Town, Department of Anaesthesia and Perioperative Medicine, Cape Town, South Africa
Background: Research evidence investigating and supporting physiotherapy management strategies for adult patients with major chest injuries is scarce. The existing evidence is primarily descriptive of physiotherapy service provision or investigates multidisciplinary approaches or interventions with little emphasis on specific physiotherapy techniques used.
Purpose: The purpose of this survey was to investigate the interventions and outcome measures that physiotherapists use in the management of patients with major chest trauma in order to describe the global trend in physiotherapy management of such patients by expert clinicians.
Methods: A REDCap based survey was used to gather information on the management of patients with major chest trauma by physiotherapists. The survey consisted of 20 questions and information was sought on surgical management, respiratory and musculoskeletal interventions, pain management techniques, and use of outcome measures. Senior physiotherapists working in major trauma units in developing and developed countries were invited to participate. A strategic and purposive sampling method was used to identify these physiotherapists.
Results: Forty-nine physiotherapists from 13 countries (5 continents), with a median of 10 years of work experience in trauma settings, participated (response rate 51%; 49/96). Most reported having no specialised trauma team in their unit (n=22; 44%) and 14 respondents (28%) reported that they had a dedicated trauma physiotherapist in their unit. Respiratory therapy interventions were reported to be 'frequently used' by majority (>75%) of respondents and included active cycle of breathing technique, deep breathing exercises, active cough, huffing, ambulation, and body positioning for ventilation-perfusion matching. Respiratory interventions 'rarely/never used' included manual hyperinflation, cough assist, intermittent positive pressure breathing, inspiratory muscle training, and initiation of non-invasive ventilation. Musculoskeletal rehabilitation interventions reported to be 'frequently used' by the majority of respondents (>75%) included sitting patients out of bed, sit to stand activities and ambulation. Interventions less frequently used included shoulder (n=34; 68%) and trunk range of motion exercises (n=30; 60%) and stair climbing (n=34; 68%). Education strategies to reduce the level of pain experienced were 'infrequently used'. Most respondents reported 'rarely/never' using other interventions for pain management such as TENS, kinesiotaping or nitrous oxide/Entonox administration. Surgical rib fixation is a management strategy used at 21 respondents' trauma units (42%). Few respondents reported using recognized outcome measures to assist with discharge planning. Only four respondents (8%) reported providing post-discharge rehabilitation to patients following major chest trauma.
Conclusion(s): Patients with chest trauma appear to be treated with traditional breathing exercises and positioning/mobilisation but seldom receive educational strategies to reduce pain. The dearth of high level evidence in this area highlights a need for further studies to investigate the efficacy of physiotherapy interventions to improve short and long term outcomes for patients following major chest trauma.
Implications: This global survey describes current physiotherapy management practices of patients with major chest trauma. It provides a platform from which further research in this neglected patient population can be conducted.
Keywords: Major chest trauma, Physiotherapy
Funding acknowledgements: Not applicable
Purpose: The purpose of this survey was to investigate the interventions and outcome measures that physiotherapists use in the management of patients with major chest trauma in order to describe the global trend in physiotherapy management of such patients by expert clinicians.
Methods: A REDCap based survey was used to gather information on the management of patients with major chest trauma by physiotherapists. The survey consisted of 20 questions and information was sought on surgical management, respiratory and musculoskeletal interventions, pain management techniques, and use of outcome measures. Senior physiotherapists working in major trauma units in developing and developed countries were invited to participate. A strategic and purposive sampling method was used to identify these physiotherapists.
Results: Forty-nine physiotherapists from 13 countries (5 continents), with a median of 10 years of work experience in trauma settings, participated (response rate 51%; 49/96). Most reported having no specialised trauma team in their unit (n=22; 44%) and 14 respondents (28%) reported that they had a dedicated trauma physiotherapist in their unit. Respiratory therapy interventions were reported to be 'frequently used' by majority (>75%) of respondents and included active cycle of breathing technique, deep breathing exercises, active cough, huffing, ambulation, and body positioning for ventilation-perfusion matching. Respiratory interventions 'rarely/never used' included manual hyperinflation, cough assist, intermittent positive pressure breathing, inspiratory muscle training, and initiation of non-invasive ventilation. Musculoskeletal rehabilitation interventions reported to be 'frequently used' by the majority of respondents (>75%) included sitting patients out of bed, sit to stand activities and ambulation. Interventions less frequently used included shoulder (n=34; 68%) and trunk range of motion exercises (n=30; 60%) and stair climbing (n=34; 68%). Education strategies to reduce the level of pain experienced were 'infrequently used'. Most respondents reported 'rarely/never' using other interventions for pain management such as TENS, kinesiotaping or nitrous oxide/Entonox administration. Surgical rib fixation is a management strategy used at 21 respondents' trauma units (42%). Few respondents reported using recognized outcome measures to assist with discharge planning. Only four respondents (8%) reported providing post-discharge rehabilitation to patients following major chest trauma.
Conclusion(s): Patients with chest trauma appear to be treated with traditional breathing exercises and positioning/mobilisation but seldom receive educational strategies to reduce pain. The dearth of high level evidence in this area highlights a need for further studies to investigate the efficacy of physiotherapy interventions to improve short and long term outcomes for patients following major chest trauma.
Implications: This global survey describes current physiotherapy management practices of patients with major chest trauma. It provides a platform from which further research in this neglected patient population can be conducted.
Keywords: Major chest trauma, Physiotherapy
Funding acknowledgements: Not applicable
Topic: Cardiorespiratory
Ethics approval required: Yes
Institution: University of the Witwatersrand and University of Cape Town
Ethics committee: Human Research Ethics (Medical) committees
Ethics number: Wits Univ (M171117) and UCT (119/2018)
All authors, affiliations and abstracts have been published as submitted.
