Department of Interdisciplinary Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
Physiotherapy. 2013 Jun;99(2):139-45. doi: 10.1016/j.physio.2012.05.005. Epub 2012 Jul 15.
To compare the physiotherapy service provided when therapists' decisions are guided by an evidence-based protocol with usual care (i.e. patient management based on therapists' clinical decisions).
Exploratory, controlled, pragmatic sequential time block clinical trial.
Level 3 surgical unit in a tertiary hospital in South Africa.
All patients admitted consecutively to the surgical unit over a 3-month period were allocated to usual or protocol care based on date of admission.
Usual care was provided by clinicians from the hospital department, and non-specialised physiotherapists were appointed as locum tenens to provide evidence-based protocol care.
Patient waiting time, frequency of treatment sessions, tasks performed and adverse events.
During protocol-care periods, treatment sessions were provided more frequently (P<0.001) and with a shorter waiting period (P<0.001). It was more likely for a rehabilitation management option to be included in a treatment session during protocol-care periods (odds ratio 2.34, 95% confidence interval 1.66 to 3.43; P<0.001). No difference in the risk of an adverse event was found between protocol-care and usual-care periods (P=0.34).
Physiotherapy services provided in intensive care units (ICUs) when the decisions of non-specialised therapists are guided by an evidence-based protocol are safe, differ from usual care, and reflect international consensus on current best evidence for physiotherapy in ICUs. Non-specialised therapists can use this protocol to provide evidence-based physiotherapy services to their patients. Future trials are needed to establish whether or not this will improve patient outcome.
比较当治疗师的决策由基于证据的方案指导时提供的物理治疗服务与常规护理（即基于治疗师临床决策的患者管理）。
探索性、对照、实用序贯时间块临床试验。
南非一家三级医院的 3 级外科病房。
在 3 个月期间连续入住外科病房的所有患者，根据入院日期分配到常规或方案护理。
常规护理由医院科室的临床医生提供，非专业物理治疗师被任命为临时工，提供基于证据的方案护理。
患者等待时间、治疗次数、执行任务和不良事件。
在方案护理期间，治疗次数更频繁（P<0.001），等待时间更短（P<0.001）。在方案护理期间，更有可能在治疗会议中纳入康复管理选项（比值比 2.34，95%置信区间 1.66 至 3.43；P<0.001）。在方案护理和常规护理期间，不良事件的风险无差异（P=0.34）。
当非专业治疗师的决策由基于证据的方案指导时，在重症监护病房（ICU）提供的物理治疗服务是安全的，与常规护理不同，并反映了国际上对 ICU 中物理治疗的当前最佳证据的共识。非专业治疗师可以使用此方案为患者提供基于证据的物理治疗服务。需要进一步的试验来确定这是否会改善患者的结局。
