File
Lottering M.A.1, Van Aswegen H.1
1University of the Witwatersrand, Physiotherapy, Johanesburg, South Africa
Background: Physiotherapists are integral members of the inter-professional team that provides care and rehabilitation for patients in intensive care units (ICUs). A pilot survey was done to determine the scope of practice of physiotherapists in South African ICUs and was published eleven years ago. Defining current practice of physiotherapists working in ICU is important to assist with the development of clinical practice guidelines.
Purpose: To describe the current practice of physiotherapists in ICUs in South Africa, determine if physiotherapists' practice has changed since the previous report, and determine if current practice is evidence based.
Methods: A cross-sectional, quantitative, descriptive, survey-based study was conducted. A questionnaire was developed and content validated. Physiotherapists who worked in adult ICU settings in public or private sector hospitals nationwide for three years or longer or who were members of the South African Society of Physiotherapy were identified and invited to participate. The questionnaire was made available to participants electronically and in hard copy, if requested. Participants were given three months from May 2013 to complete and submit the questionnaires. Participants received two reminder emails or telephone calls.
Results: Seventy-one public sector hospitals and 125 private sector hospitals, that had ICUs at the time of the survey, were identified. A total of 319 questionnaires (n=252 electronic and n=67 postal) were sent out to identified physiotherapists. The survey response rate was 33.9% (n=108). Physiotherapists working in private sector hospitals made up 60.2% (n=65) of respondents. Patient assessment techniques performed very often included ICU chart assessment (n=90, 83.3%), chest auscultation (n=94, 81.8%) and cough effort (n=81, 75%). Treatment techniques performed very often included manual chest clearance techniques (n=84, 77.8%), in-bed mobilisation and in-bed positioning (n=91, 84.3%; n=91, 84.3% respectively), airway suctioning (n=89, 82.4%), out-of-bed mobilisation (n=84, 77.8%) deep breathing exercises (n=83, 76.9%) and peripheral muscle strengthening exercises (n=72, 73.1%). More respondents used intermittent positive pressure breathing (57% v. 28%, p=0.00), adjusted mechanical ventilation (MV) settings (30% v. 15%, p=0.01), were involved in weaning patients from MV (42% v. 19% p=0.00) and used incentive spirometry (76% v. 46% p=0.00) than reported previously. More respondents performed suctioning (99% v. 70% p=0.00), extubation (60% v. 25% p=0.00) and adjustment of MV settings (30% v. 12%, p=0.02) than reported internationally.
Conclusion(s): A description of current physiotherapy practice in South African ICUs is provided. Current physiotherapy practice in ICU seems to be evidence based. The results from this survey can be used to develop preliminary clinical practice guidelines for physiotherapists working in ICU in South Africa.
Implications: Patient care in South African ICUs focuses largely on implementation of mobilisation, exercise therapy and the use of multimodality respiratory therapy.
Funding acknowledgements: The Research Foundation of the South African Society of Physiotherapy (SASP)
Topic: Cardiorespiratory
Ethics approval: Approved by the University of the Witwatersrand Human Research Ethics Medical Committee (Clearance no. M130131).
All authors, affiliations and abstracts have been published as submitted.
