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Physical Therapy in the Intensive Care Unit

 

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PTICU

Physical Therapy in the Intensive Care Unit

Bryan Mull, SPT

Background

During my second clinical rotation in the spring of 2014, I was treating patients in a variety of acute care settings at Presbyterian Hospital in Charlotte, NC. As a student with limited experience, I found myself more comfortable treating patients that were medically stable on the general units compared to the ones with more medical involved located in the intensive care areas of the hospital. Not only did I feel a bit intimidated, but also I noticed that families and caregivers were also uneasy and nervous about having their critically ill, and in their minds fragile, loved ones participating in exercises and mobility. I realized that I came into this clinical having only briefly been lectured on the advantages of early mobility. Not only this, but most of the education on early mobility in the critical care setting is targeted towards physicians and members of the medical team. In my discussions with Benita Hall, senior trauma physical therapist at UNC Hospitals, I learned that they currently have no educational materials to provide to patients or families/caregivers about the importance of early mobility and exercise in the intensive care setting. I have also discussed with several classmates the need for student physical therapists to be more knowledgeable about these benefits prior to treating patients who are critically involved to not only increase their confidence, but to improve their abilities to provide reassurance and education to patients and their caregivers. The need for improved student education regarding the benefits and considerations for providing physical therapy in the intensive care setting and the need for effective patient/family education materials formed the basis for my Capstone project.

Purpose

This Capstone project directly relates to my desire to work as a licensed therapist in the acute care setting upon graduation. Completing a literature search and disseminating the products of this project will hopefully prepare me to provide patient and family education about the benefits of physical therapy in a critical care setting. Ultimately, I want to be a clinical instructor for future physical therapy students in a large teaching hospital. Providing education and receiving feedback at the conclusion of this project designed for physical therapy students about to begin acute care rotations will prepare me for how to effectively educate future students on their clinical affiliations.

Products

  1. The first product of my Capstone was an evidence table of recently published literature on the benefits, risks, indications, and contraindications of early mobility in the intensive care setting. This evidence table helped organize information and proved to be very useful in the creation of the other materials related to this Capstone project.
    Evidence Table
  1. I created both a PowerPoint and Voicethread presentation designed for physical therapy students about to begin their first clinical rotations in an acute care setting. This presentation was designed to synthesize information from various lectures and information that are discussed during the program and to give a PT student a general idea of what to except and how to prepare for treating a patient in an intensive care setting.
    PowerPoint
    Voicethread
  1. The educational brochure I created should be provided to families and caregivers soon after their loved ones are admitted to an intensive care unit. It provides a brief overview of the goals that physical therapists have for treating patients in this setting and the benefits they can provide to combat side effects of prolonged bed rest. The health literacy assessment I conducted showed that this brochure is at a 12th grade reading level. I found it difficult to get the reading level down any lower due to the necessity of larger words when disseminating medical care-related information. Feedback from my committee was invaluable for all of the materials in my Capstone project, but especially with this brochure. The members of my committee had far more experience interacting with families and caregivers in this environment and were able to help guide me on the best topics to include in the brochure.
    Brochure

Evaluation

In order to evaluate the overall effectiveness of this project, I created a brief survey for students (or therapists) to fill out after viewing the material. Please click here to provide feedback for my Capstone Voicethread presentation!

Acknowledgements

I owe a HUGE thanks to Benita Hall, senior trauma therapist and UNC hospitals, and Janet Elder, my clinical instructor and source of inspiration during my clinical rotation at Presbyterian Hospital last year. As my committee members, both of you devoted your time to provided detailed and constructive feedback that was instrumental in helping me create better educational material for both students and patients/caregivers with this Capstone project. I also want to thank Karen McCulloch for serving as my Capstone advisor.

 

References:

  1. Klein K. Clinical and Psychologic Effects of Early Mobilization in Patients Treated in a Neurologic ICU: A Comparative Study. Critical care medicine.2014-12-16;1.
  2. Nydahl P. Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Critical care medicine.2014-05;42:1178-1186.
  3. Witcher R. Effect of early mobilization on sedation practices in the neurosciences intensive care unit: A preimplementation and postimplementation evaluation. Journal of critical care.2014-12-11;null.
  4. Hodgson CL. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical care (London, England).2014-12-04;18:658.
  5. Nydahl P. Complications related to early mobilization of mechanically ventilated patients on Intensive Care Units. Nursing in critical care.2014-11-07;n-a-n/a.
  6. Davis J. Mobilization of ventilated older adults. Journal of geriatric physical therapy (2001).2013-10;36:162-168.
  7. Kayambu G. Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Critical care medicine.2013-06;41:1543-1554.
  8. Stiller K. Physiotherapy in intensive care: an updated systematic review. 2013-09;144:825-847.
  9. Li Z. Active mobilization for mechanically ventilated patients: a systematic review. Archives of physical medicine and rehabilitation.2013-03;94:551-561.
  10. Pires-Neto RC. Very early passive cycling exercise in mechanically ventilated critically ill patients: physiological and safety aspects–a case series. PloS one.2013;8:e74182.
  11. Yosef-Brauner O. Effect of physical therapy on muscle strength, respiratory muscles and functional parameters in patients with intensive care unit-acquired weakness. The clinical respiratory journal.2015-01;9:1-6.
  12. Dong ZH. Effects of early rehabilitation therapy on patients with mechanical ventilation. World journal of emergency medicine.2014;5:48-52.

 

 

 

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