Implementation of a protocol facilitates evidence-based physiotherapy practice in intensive care units

Area of Science:

• Medical Rehabilitation
• Clinical Practice Guidelines
• Intensive Care Unit (ICU) Management

Background:

• Physiotherapy in ICUs is crucial for patient recovery.
• Standard care relies on individual clinician judgment.
• Evidence-based protocols offer a standardized approach.

Purpose of the Study:

• To compare physiotherapy services using an evidence-based protocol versus usual care.
• To evaluate the impact of protocol-guided decisions on physiotherapy delivery in an ICU setting.

Main Methods:

• Exploratory, controlled, pragmatic sequential time block clinical trial.
• Conducted in a Level 3 surgical unit in a South African tertiary hospital.
• Patients received either usual care or protocol-guided care based on admission date.

Main Results:

• Protocol care led to more frequent treatment sessions (P<0.001) and shorter waiting times (P<0.001).
• Rehabilitation management options were more likely included in protocol care (OR 2.34, P<0.001).
• No significant difference in adverse events between groups (P=0.34).

Conclusions:

• Evidence-based protocol-guided physiotherapy is safe and effective in ICUs.
• This approach differs from usual care and aligns with international best practices.
• Non-specialised therapists can implement protocols to enhance physiotherapy services, though further research on patient outcomes is warranted.