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Newman A1,2, Solomon P1, Gravesande J1, Rotella S2, Wu S1, Topp-Nguyen N2,3, Kho M1,4, Harris J1, Fox-Robichaud A2,5
1McMaster University, School of Rehabilitation Science, Hamilton, Canada, 2Hamilton Health Sciences, Hamilton General Hospital, Hamilton, Canada, 3University of Toronto, Toronto, Canada, 4St. Joseph's Healthcare, Physiotherapy Department, Hamilton, Canada, 5McMaster University, Department of Medicine, Hamilton, Canada
Background: Patients who sustain serious neurological, orthopaedic and traumatic injuries frequently require an extended stay in an ICU. These patients often have significant injuries which may require extensive surgeries, invasive monitoring, periods of immobilization and restricted activity orders. No scoping review exists concerning the role and safety of physiotherapy interventions in the neurotrauma ICU. Without clinical practice guidelines to guide rehabilitation practice and the lack of randomized clinical trials (RCTs) or systematic reviews, this scoping review was necessary to summarize the current literature on this diverse group of patients as a means of highlighting the current role of physiotherapy in neurotrauma ICUs.
Purpose: This scoping review summarizes the literature on the safety and effectiveness of physiotherapy interventions in patients with neurotrauma injuries in the ICU, identifies literature gaps and provides recommendations for future research.
Methods: We searched five databases from inception to June 2, 2018. We included original primary research published in peer reviewed journals including retrospective studies, case studies, observational and RCTs that described physiotherapy interventions in ICU patients with neurotrauma injuries. Two reviewers reviewed the databases and independently screened English articles for eligibility. Data extracted from each article included purpose, study design, population(s), outcome measures, interventions and results. Thematic analysis and descriptive numerical summaries were performed by intervention type.
Results: 12,846 titles were screened and 72 met the inclusion criteria. Patients with neurotraumatic injuries accounted for 9,233 of 10,846 patients. Most studies were observational studies (44 (61.1%)) and RCTs (14 (19.4%)). The most common interventions were manual chest physiotherapy, manual hyperinflation, neuromuscular electrical stimulation (NMES) and early mobilization. Several authors noted that suctioning could be potentially deleterious in patients with neurological injuries, with many recommending adequate sedation be given prior to suctioning in patients with severe head injuries due to the noted increases in intracranial pressures. There was lack of consistency between treatment protocols related to mobilization and chest physiotherapy. Inconsistencies were noted regarding the length of treatment sessions, activities included, and number of daily sessions. Some populations were relatively absent from the literature, including spinal cord injuries, subdural hematomas and anoxic brain injuries. Overall, physiotherapy interventions were found to be safe with few adverse events reported.
Conclusion(s): Standardization of treatment protocols and consistent reporting of adverse events is recommended as a means of determining the best prescription of interventions for patients with critical illness and to allow for better translation of this information into clinical practice. Participant heterogeneity with respect to neurotrauma diagnosis and a lack of subgroup analyses limits generalizability of the results within specific populations. Considering the frequency of its application in clinical practice, further safety evaluations are needed with respect to tracheal suctioning in patients with severe head injuries. Long term functional outcomes and quality of life require further investigation in this diverse population.
Implications: This scoping review highlights the need for standardized reporting of treatment interventions and adverse events within the rehabilitation literature. There is a need for higher methodological quality literature, with larger sample sizes, to evaluate rehabilitation effectiveness in homogeneous populations.
Keywords: Scoping Review, Neurotrauma, Critical Care
Funding acknowledgements: This work was generously supported by the Hamilton Health Sciences Foundation.
Purpose: This scoping review summarizes the literature on the safety and effectiveness of physiotherapy interventions in patients with neurotrauma injuries in the ICU, identifies literature gaps and provides recommendations for future research.
Methods: We searched five databases from inception to June 2, 2018. We included original primary research published in peer reviewed journals including retrospective studies, case studies, observational and RCTs that described physiotherapy interventions in ICU patients with neurotrauma injuries. Two reviewers reviewed the databases and independently screened English articles for eligibility. Data extracted from each article included purpose, study design, population(s), outcome measures, interventions and results. Thematic analysis and descriptive numerical summaries were performed by intervention type.
Results: 12,846 titles were screened and 72 met the inclusion criteria. Patients with neurotraumatic injuries accounted for 9,233 of 10,846 patients. Most studies were observational studies (44 (61.1%)) and RCTs (14 (19.4%)). The most common interventions were manual chest physiotherapy, manual hyperinflation, neuromuscular electrical stimulation (NMES) and early mobilization. Several authors noted that suctioning could be potentially deleterious in patients with neurological injuries, with many recommending adequate sedation be given prior to suctioning in patients with severe head injuries due to the noted increases in intracranial pressures. There was lack of consistency between treatment protocols related to mobilization and chest physiotherapy. Inconsistencies were noted regarding the length of treatment sessions, activities included, and number of daily sessions. Some populations were relatively absent from the literature, including spinal cord injuries, subdural hematomas and anoxic brain injuries. Overall, physiotherapy interventions were found to be safe with few adverse events reported.
Conclusion(s): Standardization of treatment protocols and consistent reporting of adverse events is recommended as a means of determining the best prescription of interventions for patients with critical illness and to allow for better translation of this information into clinical practice. Participant heterogeneity with respect to neurotrauma diagnosis and a lack of subgroup analyses limits generalizability of the results within specific populations. Considering the frequency of its application in clinical practice, further safety evaluations are needed with respect to tracheal suctioning in patients with severe head injuries. Long term functional outcomes and quality of life require further investigation in this diverse population.
Implications: This scoping review highlights the need for standardized reporting of treatment interventions and adverse events within the rehabilitation literature. There is a need for higher methodological quality literature, with larger sample sizes, to evaluate rehabilitation effectiveness in homogeneous populations.
Keywords: Scoping Review, Neurotrauma, Critical Care
Funding acknowledgements: This work was generously supported by the Hamilton Health Sciences Foundation.
Topic: Critical care; Cardiorespiratory
Ethics approval required: No
Institution: Hamilton Health Sciences
Ethics committee: Hamilton Integrated Research Ethics Board
Reason not required: We searched online databases for peer-reviewed articles. No patients were involved.
All authors, affiliations and abstracts have been published as submitted.
