This observational, cross-sectional study aimed to (1) obtain an international picture of physiotherapy provision across ICUs in Europe, (2) explore the role of physiotherapists in the delivery of respiratory care and rehabilitation in ICU.
An a-priori piloted survey, translated into 11 European languages (English, French, German, Spanish, Portuguese, Polish, Italian, Finnish, Greek, Albanian, Ukrainian), was disseminated through a secure, online platform (JISK V.2). Three survey sections targeted ICU structure, physiotherapy roles, and current practice. We primarily invited the responsible physiotherapists across Europe, or in their absence a senior team member, to provide one response per ICU. To maximize recruitment, national and international professional societies, professional networks, and social media were utilised, supported by an international steering committee. Ethical approval was obtained. Data was analysed descriptively and graphically.
The survey was open for 5 months from 19th February to 21st July 2024. After removal of duplicates, 845 responses from 33 different countries were included. Countries with the most responses were Spain (n=98, 12%), UK (n=95, 11%) and France (n=89, 11%). The majority of responders were physiotherapists (n=739, 87%) working in university hospitals (n=583, 69%) with adult patients (n=731, 86.5%). A total of 346 (41%) of responders reported dedicated physiotherapists on ICU, 389 (46%) shared between ICU and other wards, and 74 (9%) were general physiotherapists who saw patients on an ad-hoc basis. Belgium and France had the highest proportion of physiotherapists dedicated to work in ICU only (77% and 66%, respectively). Over half (n= 435, 51.8%) of responders reported referrals were required to initiate physiotherapy. Most physiotherapists (n=335, 45%) worked >10 years in ICU. The majority of responders (n=777, 91%) indicated that they had received some form of ICU specific training, although 39% (n=288) had never attended ICU specific conferences. The majority of responders treated mechanically ventilated patients, providing both respiratory care and rehabilitation (n=623, 84%). One in ten responders provided rehabilitation only (n=76), and 24 (3%) did not provide any input whilst patients were invasively ventilated. Variability was seen regarding respiratory techniques, whereby suctioning, manual hyperinflation and Mechanical Insufflation-Exsufflation were not performed by 24% (n=156), 42% (n=268) and 19% (n=268), respectively. Early mobilisation techniques for ventilated patients such as sitting at the edge of bed were used by three quarters of responders (n=539, 76%), though some only performed this occasionally (n=165, 23%) or never (n=28, 4%).
This large, rigorous study provides an overview of current ICU physiotherapy provision and practice across Europe including previously underreported Eastern countries. Thereby identifying, various levels of access to specialised ICU physiotherapy, along with a wide variation in expertise or specific techniques.
These results identify potential educational needs to inform the development of future training and workforce planning, ultimately improving interprofessional ICU care across Europe, particularly in underrepresented areas.
Workforce
Early mobilisation
