File
A.N.L. Newman1,2, M.E. Kho1,3, J.E. Harris1, A. Fox-Robichaud4,2, P. Solomon1
1McMaster University, School of Rehabilitation Science, Hamilton, Canada, 2Hamilton Health Sciences, Critical Care, Hamilton, Canada, 3St. Joseph's Healthcare Hamilton, Physiotherapy, Hamilton, Canada, 4McMaster University, Medicine, Hamilton, Canada
Background: Improvements in medical technology and non-invasive cardiac revascularization have delayed the need for cardiac surgery. Consequently, patients undergoing cardiac surgery are older and have more comorbidities, leading to increased case complexity and increased risk of developing a post-operative critical illness. There remains a lack of information about how early mobilization and other critical care physiotherapy interventions are being implemented at the bedside in the cardiac surgical ICU and the factors which facilitate or impede the initiation of physiotherapy. Previous surveys provided insights into routine physiotherapy provided post-uncomplicated cardiac surgery. However, the role of physiotherapy with critically ill, off-track patients, who require prolonged ICU stays, has not been investigated.
Purpose: The purpose of this study was to describe reported current physiotherapy practice for adult patients requiring prolonged critical care stays in ICU (> 3 days) post complicated cardiac surgery in Ontario, Canada.
Methods: We distributed a cross-sectional, self-administered 52-item electronic survey to 35 critical care physiotherapists treating adult cardiac surgery patients at 11 cardiac surgical sites in Ontario. We developed a 73-item preliminary version of the survey guided by the literature and clinical expertise. Item reduction was preformed by 3 physiotherapists with previous cardiac surgery experience. Pilot testing and clinical sensibility testing were conducted prior to administration. Participants were sent 4 email reminders prior to link expiry. Upon completion, participants received a gift card.
Results: Twenty-seven complete and 1 partially completed surveys were received for a response rate of 80% (28/35). The median [IQR] reported number of cardiac surgeries performed/week was 30 [10] with a median number of 14.5 [4] cardiac surgery beds/site. Typical reported caseloads ranged from 6 to 10 patients/day/therapist. Ninety-three percent initiated physiotherapy with patients once clinically stable, with range of motion exercises (27/28, 96.4%), manual chest physiotherapy (26/28, 92.9%) and sitting at edge of bed (25/28, 89.3%) the most common treatments. Patient acuity was the most frequently endorsed barrier to physiotherapy implementation (19/28, 67.9%). The most frequently endorsed facilitator stated by 25/28 (89.3%) of respondents was availability of adequate nursing staff. Intra-aortic balloon pump and extracorporeal membrane oxygenation appeared to limit physiotherapy practice. Outcome measures use was limited, with 46% of respondents (13/28) reporting they did not routinely use outcome measures to assess changes in functional status.
Conclusion(s): This is the first survey to focus on the role of physiotherapy in the treatment of critically ill, off-track patients post cardiac surgery. Based on typical daily shift length and caseload, some physiotherapists may have limited capacity to treat every patient daily or to initiate adjunct treatments. Outcome measure use was limited, a common issue within physiotherapy practice. Larger studies are required to determine the safety, feasibility, and effectiveness of physiotherapy interventions in patients with advanced life support devices.
Implications: There is an implementation gap between research findings and stated clinical practice with respect to the use of outcome measures that requires further evaluation. These results can help guide the development of future national surveys and observational studies of frontline physiotherapy practice in cardiac surgical critical care.
Funding, acknowledgements: This work was generously supported by the Hamilton Health Sciences Foundation.
Keywords: Physiotherapy, Cardiac Surgery, Critical Care
Topic: Critical care
Did this work require ethics approval? Yes
Institution: Hamilton Health Sciences
Committee: Hamilton Integrated Research Ethics Board
Ethics number: 5620
All authors, affiliations and abstracts have been published as submitted.
