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The way in which a physiotherapy service is structured can improve patient outcome from a surgical intensive care: a controlled clinical trial.

Hanekom SD, Louw Q, Coetzee A - Crit Care (2012)

Bottom Line: We must determine the optimal service approach that will result in improved patient outcome.The aim of this article is to report on the estimated effect of providing a physiotherapy service consisting of an exclusively allocated physiotherapist providing evidence-based/protocol care, compared with usual care on patient outcomes.This could be a more cost-effective service approach to care than is usual care.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: The physiological basis of physiotherapeutic interventions used in intensive care has been established. We must determine the optimal service approach that will result in improved patient outcome. The aim of this article is to report on the estimated effect of providing a physiotherapy service consisting of an exclusively allocated physiotherapist providing evidence-based/protocol care, compared with usual care on patient outcomes.

Methods: An exploratory, controlled, pragmatic, sequential-time-block clinical trial was conducted in the surgical unit of a tertiary hospital in South Africa. Protocol care (3 weeks) and usual care (3 weeks) was provided consecutively for two 6-week intervention periods. Each intervention period was followed by a washout period. The physiotherapy care provided was based on the unit admission date. Data were analyzed with Statistica in consultation with a statistician. Where indicated, relative risks with 95% confidence intervals (CIs) are reported. Significant differences between groups or across time are reported at the alpha level of 0.05. All reported P values are two-sided.

Results: Data of 193 admissions were analyzed. No difference was noted between the two patient groups at baseline. Patients admitted to the unit during protocol care were less likely to be intubated after unit admission (RR, 0.16; 95% CI, 0.07 to 0.71; RRR, 0.84; NNT, 5.02; P = 0.005) or to fail an extubation (RR, 0.23; 95% CI, 0.05 to 0.98; RRR, 0.77; NNT, 6.95; P = 0.04). The mean difference in the cumulative daily unit TISS-28 score during the two intervention periods was 1.99 (95% CI, 0.65 to 3.35) TISS-28 units (P = 0.04). Protocol-care patients were discharged from the hospital 4 days earlier than usual-care patients (P = 0.05). A tendency noted for more patients to reach independence in the transfers (P = 0.07) and mobility (P = 0.09) categories of the Barthel Index.

Conclusions: A physiotherapy service approach that includes an exclusively allocated physiotherapist providing evidence-based/protocol care that addresses pulmonary dysfunction and promotes early mobility improves patient outcome. This could be a more cost-effective service approach to care than is usual care. This information can now be considered by administrators in the management of scarce physiotherapy resources and by researchers in the planning of a multicenter randomized controlled trial.

Trial registration: PACTR201206000389290.

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Figure 1: Flowchart to direct algorithm use.

Mentions: This study was motivated by the lack of information available to guide the organization of physiotherapy services that would ensure optimal outcome for surgical ICU patients. The development and implementation of protocols based on best available evidence have been advocated to address practice variation [20], facilitate clinical decision making [21], and optimize evidence utilization by practitioners [22]. We developed an evidence-based protocol consisting of five clinical-management algorithms. This protocol was validated by a group of 27 national and international experts. The protocol addressed pulmonary dysfunction, muscle weakness, and functional insufficiencies in the surgical population (Figure 1) [23-25]. We reported in an earlier article that the implementation of the evidence-based physiotherapy protocol resulted in a physiotherapy service that was significantly different from usual care (Table 1) [26]. The aim of this article is to report on the estimated effect of providing a physiotherapy service consisting of an exclusively allocated physiotherapist providing evidence-based/protocol care, compared with usual care on patient outcomes.


The way in which a physiotherapy service is structured can improve patient outcome from a surgical intensive care: a controlled clinical trial.

Hanekom SD, Louw Q, Coetzee A - Crit Care (2012)

Flowchart to direct algorithm use.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672619&req=5

Figure 1: Flowchart to direct algorithm use.
Mentions: This study was motivated by the lack of information available to guide the organization of physiotherapy services that would ensure optimal outcome for surgical ICU patients. The development and implementation of protocols based on best available evidence have been advocated to address practice variation [20], facilitate clinical decision making [21], and optimize evidence utilization by practitioners [22]. We developed an evidence-based protocol consisting of five clinical-management algorithms. This protocol was validated by a group of 27 national and international experts. The protocol addressed pulmonary dysfunction, muscle weakness, and functional insufficiencies in the surgical population (Figure 1) [23-25]. We reported in an earlier article that the implementation of the evidence-based physiotherapy protocol resulted in a physiotherapy service that was significantly different from usual care (Table 1) [26]. The aim of this article is to report on the estimated effect of providing a physiotherapy service consisting of an exclusively allocated physiotherapist providing evidence-based/protocol care, compared with usual care on patient outcomes.

Bottom Line: We must determine the optimal service approach that will result in improved patient outcome.The aim of this article is to report on the estimated effect of providing a physiotherapy service consisting of an exclusively allocated physiotherapist providing evidence-based/protocol care, compared with usual care on patient outcomes.This could be a more cost-effective service approach to care than is usual care.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: The physiological basis of physiotherapeutic interventions used in intensive care has been established. We must determine the optimal service approach that will result in improved patient outcome. The aim of this article is to report on the estimated effect of providing a physiotherapy service consisting of an exclusively allocated physiotherapist providing evidence-based/protocol care, compared with usual care on patient outcomes.

Methods: An exploratory, controlled, pragmatic, sequential-time-block clinical trial was conducted in the surgical unit of a tertiary hospital in South Africa. Protocol care (3 weeks) and usual care (3 weeks) was provided consecutively for two 6-week intervention periods. Each intervention period was followed by a washout period. The physiotherapy care provided was based on the unit admission date. Data were analyzed with Statistica in consultation with a statistician. Where indicated, relative risks with 95% confidence intervals (CIs) are reported. Significant differences between groups or across time are reported at the alpha level of 0.05. All reported P values are two-sided.

Results: Data of 193 admissions were analyzed. No difference was noted between the two patient groups at baseline. Patients admitted to the unit during protocol care were less likely to be intubated after unit admission (RR, 0.16; 95% CI, 0.07 to 0.71; RRR, 0.84; NNT, 5.02; P = 0.005) or to fail an extubation (RR, 0.23; 95% CI, 0.05 to 0.98; RRR, 0.77; NNT, 6.95; P = 0.04). The mean difference in the cumulative daily unit TISS-28 score during the two intervention periods was 1.99 (95% CI, 0.65 to 3.35) TISS-28 units (P = 0.04). Protocol-care patients were discharged from the hospital 4 days earlier than usual-care patients (P = 0.05). A tendency noted for more patients to reach independence in the transfers (P = 0.07) and mobility (P = 0.09) categories of the Barthel Index.

Conclusions: A physiotherapy service approach that includes an exclusively allocated physiotherapist providing evidence-based/protocol care that addresses pulmonary dysfunction and promotes early mobility improves patient outcome. This could be a more cost-effective service approach to care than is usual care. This information can now be considered by administrators in the management of scarce physiotherapy resources and by researchers in the planning of a multicenter randomized controlled trial.

Trial registration: PACTR201206000389290.

Show MeSH