Physiotherapy practice in South African intensive care units

Abstract

Background. Physiotherapists are integral members of the interprofessional team that provides care and rehabilitation for patients in intensive
care units (ICUs).
Objectives. To describe the current practice of physiotherapists in ICUs, determine if physiotherapists’ practice has changed since a previous
report and determine if practice is evidence based.
Methodology. A questionnaire was content validated and made available electronically and in hard copy. Physiotherapists who work in ICUs in
public or private sector hospitals or who are members of the South African Society of Physiotherapy were identified and invited to participate.
Results. Survey response rate was 33.9%. 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
(n=101, 93.5%), in-bed mobilisation and 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), used adjustment of mechanical ventilation (MV) settings (30
v. 15%, p=0.01), were involved with 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. Physiotherapy practice in ICUs is evidence based. Care focuses largely on mobilisation, exercise therapy and multimodality
respiratory therapy.