S Hanekom1, Q A Louw, A R Coetzee. 1. Department of Interdisciplinary Health Sciences, Stellenbosch University, Stellenbosch, South Africa. sdh@sun.ac.za
Abstract
OBJECTIVES: To compare the physiotherapy service provided when therapists' decisions are guided by an evidence-based protocol with usual care (i.e. patient management based on therapists' clinical decisions). DESIGN: Exploratory, controlled, pragmatic sequential time block clinical trial. SETTING: Level 3 surgical unit in a tertiary hospital in South Africa. PARTICIPANTS: All patients admitted consecutively to the surgical unit over a 3-month period were allocated to usual or protocol care based on date of admission. INTERVENTIONS: Usual care was provided by clinicians from the hospital department, and non-specialised physiotherapists were appointed as locum tenens to provide evidence-based protocol care. MAIN OUTCOME MEASURES: Patient waiting time, frequency of treatment sessions, tasks performed and adverse events. RESULTS: During protocol-care periods, treatment sessions were provided more frequently (P<0.001) and with a shorter waiting period (P<0.001). It was more likely for a rehabilitation management option to be included in a treatment session during protocol-care periods (odds ratio 2.34, 95% confidence interval 1.66 to 3.43; P<0.001). No difference in the risk of an adverse event was found between protocol-care and usual-care periods (P=0.34). CONCLUSIONS: Physiotherapy services provided in intensive care units (ICUs) when the decisions of non-specialised therapists are guided by an evidence-based protocol are safe, differ from usual care, and reflect international consensus on current best evidence for physiotherapy in ICUs. Non-specialised therapists can use this protocol to provide evidence-based physiotherapy services to their patients. Future trials are needed to establish whether or not this will improve patient outcome.
OBJECTIVES: To compare the physiotherapy service provided when therapists' decisions are guided by an evidence-based protocol with usual care (i.e. patient management based on therapists' clinical decisions). DESIGN: Exploratory, controlled, pragmatic sequential time block clinical trial. SETTING: Level 3 surgical unit in a tertiary hospital in South Africa. PARTICIPANTS: All patients admitted consecutively to the surgical unit over a 3-month period were allocated to usual or protocol care based on date of admission. INTERVENTIONS: Usual care was provided by clinicians from the hospital department, and non-specialised physiotherapists were appointed as locum tenens to provide evidence-based protocol care. MAIN OUTCOME MEASURES: Patient waiting time, frequency of treatment sessions, tasks performed and adverse events. RESULTS: During protocol-care periods, treatment sessions were provided more frequently (P<0.001) and with a shorter waiting period (P<0.001). It was more likely for a rehabilitation management option to be included in a treatment session during protocol-care periods (odds ratio 2.34, 95% confidence interval 1.66 to 3.43; P<0.001). No difference in the risk of an adverse event was found between protocol-care and usual-care periods (P=0.34). CONCLUSIONS: Physiotherapy services provided in intensive care units (ICUs) when the decisions of non-specialised therapists are guided by an evidence-based protocol are safe, differ from usual care, and reflect international consensus on current best evidence for physiotherapy in ICUs. Non-specialised therapists can use this protocol to provide evidence-based physiotherapy services to their patients. Future trials are needed to establish whether or not this will improve patient outcome.
Authors: Selina M Parry; Laura D Knight; Bronwen Connolly; Claire Baldwin; Zudin Puthucheary; Peter Morris; Jessica Mortimore; Nicholas Hart; Linda Denehy; Catherine L Granger Journal: Intensive Care Med Date: 2017-02-16 Impact factor: 17.440
Authors: P Nydahl; R Dubb; S Filipovic; C Hermes; F Jüttner; A Kaltwasser; S Klarmann; H Mende; S Nessizius; C Rottensteiner Journal: Med Klin Intensivmed Notfmed Date: 2016-09-06 Impact factor: 0.840
Authors: Shannon L Goddard; Fabiana Lorencatto; Ellen Koo; Louise Rose; Eddy Fan; Michelle E Kho; Dale M Needham; Gordon D Rubenfeld; Jill J Francis; Brian H Cuthbertson Journal: J Intensive Care Date: 2018-01-23