Minimum standards of clinical practice for physical therapists working in intensive care units in Japan

Perme ICU Physical Therapy Competency: Development of an ICU Knowledge and Skills Assessment Tool

BACKGROUND

Physical therapy for patients in the ICU is advanced practice demanding specialized knowledge and skills. However, ICU physical therapy competency standards lack uniformity or defined processes.

OBJECTIVES

To describe the development process of the Perme ICU Physical Therapy Competency and to assess its face and content validity.

METHODS

Quantitative research study for the content validation of the Perme ICU Physical Therapy Competency using a panel of experts. The face validity assessment consisted of two informal surveys and discussions with clinicians representing various disciplines in ICU.

MAIN OUTCOME MEASURES

A content validation survey included analysis of sufficiency, clarity, coherence, and relevance for items in the Perme ICU Physical Therapy Competency. For the quantitative analysis of content validity, the item-level content validity index (I-CVI) was used. Scale-level content validity index based on the universal agreement method (S-CVI/UA) was calculated as the proportion of items on the scale that achieve a relevance scale of 3 or 4 by all experts. Scale-level content validity index was calculated based on the average method (S-CVI/Ave).

RESULTS

The sufficiency, clarity, coherence, and relevance of the Perme ICU Physical Therapy Competency items presented S-CVI/Ave greater than 80 % (97 %, 97 %, 99 %, 95 %, respectively).

CONCLUSION

This study establishes that the Perme ICU Physical Therapy Competency has a satisfactory level of face and content validity.

IMPLICATIONS FOR CLINICAL PRACTICE

The Perme ICU Physical Therapy Competency, with its solid framework, is a valuable assessment tool applicable for integration in any ICU competency program. It can be utilized as a self-assessment tool by individual therapists or in collaboration with mentors and evaluators to evaluate knowledge and skills effectively. This innovative tool not only enhances clinical practice but also presents an opportunity for advancing the physical therapy profession within the ICU setting.

Critical care beyond organ support: the importance of geriatric rehabilitation

Very old critically ill patients pose a growing challenge for intensive care. Critical illness and the burden of treatment in the intensive care unit (ICU) can lead to a long-lasting decline of functional and cognitive abilities, especially in very old patients. Multi-complexity and increased vulnerability to stress in these patients may lead to new and worsening disabilities, requiring careful assessment, prevention and rehabilitation. The potential for rehabilitation, which is crucial for optimal functional outcomes, requires a systematic, multi-disciplinary approach and careful long-term planning during and following ICU care. We describe this process and provide recommendations and checklists for comprehensive and timely assessments in the context of transitioning patients from ICU to post-ICU and acute hospital care, and review the barriers to the provision of good functional outcomes.

Physical therapy in the intensive care unit: A cross-sectional study of three Asian countries

BACKGROUND

Physical therapy (PT) is beneficial for critically ill patients, but the extent of its application in the intensive care unit (ICU) differs between countries. Here, we compared the extent of PT intervention in the ICU in Japan, the Philippines, and Taiwan by evaluating the sociodemographic and ICU-related profiles of ICU physical therapists.

MATERIALS AND METHODS

In this cross-sectional study, a semistructured nationwide online survey was distributed to ICU physical therapists in the three countries.

RESULTS

We analyzed the responses of 164 physical therapists from Japan, Philippines, and Taiwan. Significant differences were observed between the countries in all sociodemographic variables and the following ICU-related profiles of physical therapists: ICU work experience, duration of the ICU posting, number of hours per day spent in the ICU, on-call ICU PT service engagement, source of ICU patient referral, therapist-patient ratio, and ICU-related PT training participation (p < 0.05). Medical, surgical, and neurologic ICUs were the most common ICU workplaces of the ICU physical therapists, but only surgical and neurologic ICUs exhibited significant differences between the countries (p < 0.05). Standard PT techniques in the ICU were passive and active-assisted range of motion, positioning, and breathing exercises but were implemented with significantly different frequencies between the countries (p < 0.05). The most common challenge faced in ICU PT service delivery by respondents from all three countries was lack of training prior to ICU duty, and lack of training was even bigger challenge in Japan than in other two countries after adjustment of age, highest educational attainment, and work experience.

CONCLUSION

The differences in the health-care system between Japan, the Philippines, and Taiwan were related to differences in the compliance with internationally recommended PT practice standards in the ICU, differences in the type of PT intervention prioritized, and the challenges encountered in ICU PT service delivery.

Minimum standards of clinical practice for physiotherapists working in adult intensive care units in Singapore

Background

Physiotherapists play a crucial role in rehabilitating critically ill patients in intensive care units (ICU). However, variations are found in clinical practice amongst physiotherapists working in the ICU, both locally and internationally, due to the lack of minimum clinical standards and varying knowledge on critical care rehabilitation resulting in inconsistent quality of care.

Purpose

To establish a framework of the minimum standards of clinical practice for physiotherapists working in ICU in Singapore and compare the standards with existing literature.

Methods

A three-round modified Delphi questionnaire survey technique collated responses from ICU physiotherapists. The questionnaire contained 222 items, categorised into assessments, conditions and treatments. Responses to the items were either: “Yes, it is essential”, “No, it is not essential”, or “I am not sure”. Consensus for an item was reached when 70% of participants ranked it essential or non-essential. Participants comprised registered physiotherapists who have worked in the ICU for at least six months in the last 12 months and are currently working in the ICU.

Results

23 physiotherapists (median ICU-experience 7.0 (4.3–9.8) years) gave consent and completed the initial survey. 13 completed all three rounds of questionnaires. Overall, 163 items were regarded as essential, 21 as non-essential, and 38 did not reach consensus. The identified 163 items varied from similar studies due to different scopes of physiotherapy practice and professional autonomy.

Conclusion

This framework may guide the content of the physiotherapy education curriculum on critical care rehabilitation and minimise variability in clinical practice across different healthcare institutions in Singapore.

Expert consensus on the minimum clinical standards of practice for Nigerian physiotherapists working in intensive care units: A modified Delphi study

BACKGROUND

Management of patients in intensive care units (ICUs) needs staff with a recommended level of expertise and experience owing to the life-threatening nature of illnesses, injuries and complications that these patients present with. There are no specific guidelines governing physiotherapy practice in ICUs in Nigeria. Hence, there is a need to have expert consensus on the minimum clinical standard of practice for physiotherapists working in ICUs as a first step to proposing/developing guidelines in the future.

OBJECTIVES

To assess the expert consensus on the minimum clinical standard of practice for physiotherapists working in ICUs in Nigeria.

METHODS

Physiotherapists with working experience in Nigerian ICUs were purposively recruited into the present study using a modified Delphi technique. A questionnaire comprising 222 question items on the role of physiotherapy in critical care was adopted and administered to the participants over three rounds of Delphi procedure (online). Participants checked either 'essential', 'not essential' or 'unsure' for each question item. For each question item to be considered 'essential' or 'not essential', a consensus agreement ≥70% had to be met. Questions without consensus were further modified by providing definition or clarification and presented in subsequent rounds. Data were analysed descriptively.

RESULTS

We recruited 26 expert physiotherapists who consented to the study and completed the first round of the study. The majority of the physiotherapists (n=24) remained in the study after the third round. A total of 178 question items were adjudged to be 'essential' after the first round, and a further 15 and three additional items were subsequently adjudged to be as 'essential' after modifying the outstanding question items during the second and third rounds, respectively. No consensus was reached for 24 items. None of the question items were ranked as 'not essential' after all the rounds.

CONCLUSION

Expert consensus was achieved for a substantial number of question items regarding knowledge and skills for assessment, condition and treatment items of the questionnaire by experienced critical care physiotherapists in Nigeria.