Implementation of a protocol facilitates evidence-based physiotherapy practice in intensive care units.

OBJECTIVES

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).

DESIGN

Exploratory, controlled, pragmatic sequential time block clinical trial.

SETTING

Level 3 surgical unit in a tertiary hospital in South Africa.

PARTICIPANTS

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.

INTERVENTIONS

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.

MAIN OUTCOME MEASURES

Patient waiting time, frequency of treatment sessions, tasks performed and adverse events.

RESULTS

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).

CONCLUSIONS

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.