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Jaenicke DS1, Beelen A1, van der Schaaf M1
1Amsterdam University Medical Centers, loc AMC, Rehabilitation, Amsterdam, Netherlands
Background: Early activation and mobilization have become an important part of physiotherapy treatment strategies of critically ill patients. The 2015 published Evidence Statement (ES) for physiotherapy in the Intensive Care Unit (ICU), provides recommendations on treatments along with safety criteria to determine patients' safety before and during activation and mobilization by screening on red flags and contra indications. In patients with neurological and neurosurgical admission diagnosis on the ICU, adherence to the ES appeared to be low, with underuse of activation strategies like mobilization in the chair or using the bed-cycle-ergometer.
Purpose: The objective of this study was to improve the amount of active physiotherapy interventions in neurological and neurosurgical ICU patients. We undertook a quality improvement project to raise awareness for mobilization in the chair and the use of the bed-cycle-ergometer according to ES recommendations and to evaluate its effects on ES adherence.
Methods: A before-after evaluation, performed at the ICU of a university hospital, comparing retrospective collected data of applied physiotherapy treatment strategies in 172 physiotherapy sessions before and 108 physiotherapy sessions after the intervention. The intervention consisted of interviewing ICU-physiotherapists specialized in neurology to explore perceived barriers towards implementation of the ES with respect to mobilization in the chair and the use of the bed-cycle-ergometer. Subsequently we addressed the identified barriers with different strategies:
(1) enhancing knowledge of the ES, including safety criteria for activation and mobilization,
(2) enhancing knowledge of the indication for and the skills to use the bed-cycle-ergometer,
(3) removing organizational barriers and
(4) developing an additional protocol targeting the special needs of neurological patients on the ICU.
Main outcome measures were the number of active physiotherapy interventions as indicated by the ES, in terms of mobilization in the chair or using the bed-cycle-ergometer, in neurological patients. Descriptive and inferential statistics were used to compare before-after intervention numbers.
Results: After the intervention, the number of active physiotherapy interventions in patients without contra-indications for active physiotherapy according to the safety criteria, increased from 47% to 71% (P = 0.0). Adherence to ES recommendation increased from 55% to 73% (P = 0.0). Mobilization in the chair increased from 32% to 50% (P = 0.0). The use of the bed-cycle-ergometer increased, yet non-significantly (16% vs. 21%, P = 0.4).
Conclusion(s): Implementing targeted interventions on identified barriers improved guideline adherence and increased the frequency of activation and mobilization of neurological and neurosurgical patients on the ICU.
Implications: Even in short time, targeted interventions can change clinical practice. There is still nsufficient research covering the needs of critically ill NEU/NEC patients. Further research should aim on the translation of findings in medical surgical patients towards patients with NEU/NEC admission reasons to the ICU/MCU. Furthermore, studies with focus on (long-term) effects of activation and mobilization in terms of functional outcomes and recovery are desirable.
We believe that small studies like ours are important to pave the path for further research in this patient group, where so much more experience can be gained for therapists and so much more health status might be achievable for patients.
Keywords: ICU early rehabilitation, neurological neurosurgical patients, quality improvement project
Funding acknowledgements: No specific grant from any funding agency in the public, commercial, or not-for-profit sectors was received.
Purpose: The objective of this study was to improve the amount of active physiotherapy interventions in neurological and neurosurgical ICU patients. We undertook a quality improvement project to raise awareness for mobilization in the chair and the use of the bed-cycle-ergometer according to ES recommendations and to evaluate its effects on ES adherence.
Methods: A before-after evaluation, performed at the ICU of a university hospital, comparing retrospective collected data of applied physiotherapy treatment strategies in 172 physiotherapy sessions before and 108 physiotherapy sessions after the intervention. The intervention consisted of interviewing ICU-physiotherapists specialized in neurology to explore perceived barriers towards implementation of the ES with respect to mobilization in the chair and the use of the bed-cycle-ergometer. Subsequently we addressed the identified barriers with different strategies:
(1) enhancing knowledge of the ES, including safety criteria for activation and mobilization,
(2) enhancing knowledge of the indication for and the skills to use the bed-cycle-ergometer,
(3) removing organizational barriers and
(4) developing an additional protocol targeting the special needs of neurological patients on the ICU.
Main outcome measures were the number of active physiotherapy interventions as indicated by the ES, in terms of mobilization in the chair or using the bed-cycle-ergometer, in neurological patients. Descriptive and inferential statistics were used to compare before-after intervention numbers.
Results: After the intervention, the number of active physiotherapy interventions in patients without contra-indications for active physiotherapy according to the safety criteria, increased from 47% to 71% (P = 0.0). Adherence to ES recommendation increased from 55% to 73% (P = 0.0). Mobilization in the chair increased from 32% to 50% (P = 0.0). The use of the bed-cycle-ergometer increased, yet non-significantly (16% vs. 21%, P = 0.4).
Conclusion(s): Implementing targeted interventions on identified barriers improved guideline adherence and increased the frequency of activation and mobilization of neurological and neurosurgical patients on the ICU.
Implications: Even in short time, targeted interventions can change clinical practice. There is still nsufficient research covering the needs of critically ill NEU/NEC patients. Further research should aim on the translation of findings in medical surgical patients towards patients with NEU/NEC admission reasons to the ICU/MCU. Furthermore, studies with focus on (long-term) effects of activation and mobilization in terms of functional outcomes and recovery are desirable.
We believe that small studies like ours are important to pave the path for further research in this patient group, where so much more experience can be gained for therapists and so much more health status might be achievable for patients.
Keywords: ICU early rehabilitation, neurological neurosurgical patients, quality improvement project
Funding acknowledgements: No specific grant from any funding agency in the public, commercial, or not-for-profit sectors was received.
Topic: Neurology; Neurology; Education: continuing professional development
Ethics approval required: No
Institution: AMC
Ethics committee: AMC
Reason not required: Standard Care.
All authors, affiliations and abstracts have been published as submitted.
