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Alqahtani M, Kashoo F, Alzhrani M, Ahmad F, Seyam MK, Ahmad M, Alhusaini AA, Melam GR, Buragadda S. Current Physical Therapy Practice in the Intensive Care Unit in Saudi Arabia: A Multicentre Cross-Sectional Survey. Crit Care Res Pract 2020; 2020:6610027. [PMID: 33457013 PMCID: PMC7785395 DOI: 10.1155/2020/6610027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early mobilisation of patients in the intensive care unit (ICU) is associated with positive health benefits. Research literature lacks insight into the current status of ICU physical therapy (PT) practice in the Kingdom of Saudi Arabia. AIM To determine the current standard of ICU PT practice, attitude, and barriers. METHODS A questionnaire was e-mailed to physiotherapists (PTs) working in the hospital. The questions pertained to experience, qualification, barriers, and most frequently encountered case scenarios in the ICU. RESULTS The response rate was 28.1% (124/442). Frequent cases referred to the PTs were traumatic paraplegia (n = 111, 89%) and stroke (n = 102, 82.3%) as compared to congestive heart failure (n = 20, 16.1%) and pulmonary infections (n = 7, 5.6%). The preferred treatment of choice among PTs was chest physiotherapy (n = 102, 82.2%) and positioning (n = 73, 58.8%), whereas functional electrical stimulation (n = 12, 9.6%) was least preferred irrespective of the condition. Perceived barriers in the ICU PT management were of low confidence in managing cases (n = 89, 71.7%) followed by inadequate training (n = 53, 42.7%), and the least quoted barrier was a communication gap between the critical care team members (n = 8, 6.4%). CONCLUSION PTs reported significant variation in the choice of treatment for different clinical cases inside ICU. The main barriers in the ICU setting were low confidence and inadequate training.
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Affiliation(s)
- Mazen Alqahtani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Faizan Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Msaad Alzhrani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Fuzail Ahmad
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Mohammed K. Seyam
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Mehrunnisha Ahmad
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Adel A. Alhusaini
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ganeswara Rao Melam
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Syamala Buragadda
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Koo KKY, Choong K, Cook DJ, Herridge M, Newman A, Lo V, Guyatt G, Priestap F, Campbell E, Burns KEA, Lamontagne F, Meade MO. Early mobilization of critically ill adults: a survey of knowledge, perceptions and practices of Canadian physicians and physiotherapists. CMAJ Open 2016; 4:E448-E454. [PMID: 27730109 PMCID: PMC5047804 DOI: 10.9778/cmajo.20160021] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The promotion of early mobilization following critical illness is tempered by national reports of patient and institutional barriers to this approach. We carried out a survey to assess current knowledge, perceptions and practices of Canadian physicians and physiotherapists with respect to acquired weakness and early mobilization in adults in the intensive care unit (ICU). METHODS We conducted a cross-sectional, self-administered postal survey among critical care physicians and physiotherapists in all 46 academic ICUs in Canada in 2011-2012. To identify all physicians and physiotherapists working in the ICUs, we contacted division heads and senior physiotherapists by telephone or email. We designed, tested and administered a questionnaire with the following domains: knowledge of ICU-acquired weakness and early mobilization; personal views of, perceived barriers to and adequacy of technical skills for early mobilization; assessments for initiation of early mobilization and permissible activity levels by patient physiologic characteristics, diagnoses and therapies; staffing issues; and sedation practices. RESULTS The overall response rate was 71.3% (311/436); it was 64.2% (194/302) among physicians and 87.3% (117/134) among physiotherapists. A total of 214 respondents (68.8%) underestimated the incidence of ICU-acquired weakness in the general medical-surgical ICU population, and 186 (59.8%) stated they had insufficient knowledge or skills to mobilize patients receiving mechanical ventilation. Excessive sedation, medical instability, limited staffing, safety concerns, insufficient guidelines and insufficient equipment were common perceived barriers to early mobilization. INTERPRETATION Physicians and physiotherapists in the ICU underestimated the incidence of ICU-acquired weakness and felt inadequately trained to mobilize patients receiving mechanical ventilation. We identified multiple modifiable barriers to early mobilization at the institutional, health care provider and patient levels that need to be addressed when designing mobilization programs for critically ill adults.
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Affiliation(s)
- Karen K Y Koo
- Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash
| | - Karen Choong
- Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash
| | - Deborah J Cook
- Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash
| | - Margaret Herridge
- Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash
| | - Anastasia Newman
- Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash
| | - Vincent Lo
- Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash
| | - Gordon Guyatt
- Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash
| | - Fran Priestap
- Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash
| | - Eileen Campbell
- Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash
| | - Karen E A Burns
- Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash
| | - FranÇois Lamontagne
- Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash
| | - Maureen O Meade
- Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash
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