Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Pavia.
Pulmonary Outpatient Clinic, Fondazione "Don Gnocchi", Istituto Palazzolo, Milan.
Monaldi Arch Chest Dis. 2020 Dec 30;90(4). doi: 10.4081/monaldi.2020.1412.
Early physiotherapy (EP) programs on critically ill patients in the intensive care unit (ICU) have proven to be safe, feasible and effective. However, despite being considered by all the professionals involved as a fundamental aspect of integrated care, in most cases they are inadequately applied or not performed at all. The main objective of this study is to evaluate the knowledge, perceptions and activities related to EP among physician, nurses and physiotherapists who practice in ICUs of Rome. Obstacles to its application and possible strategies to overcome them are also examined. The study was conducted according to the CHERRIES recommendations. Two questionnaires with 29 questions were created on the Google Form platform and were sent by mail to all the ICUs of public hospitals or accredited private hospitals with the National Health Service in Rome. Thirty (60%) of the contacted ICUs responded. The physiotherapist is present in 76.7% of ICUs and carries out its activities mainly during daytime hours (60.9%), for less than 3 hours in 39.1% of cases and only after a request for specialist advice (65.2%). Only in 4.3% of cases the service is guaranteed even at weekends but only after a request. All 29 professionals interviewed consider both the presence of a physiotherapist within the interdisciplinary team of the ICU and the implementation of an EP program to be necessary, supporting the positive effects of this program. The most frequently obstacles to the implementation of an EP program are clinical instability (69%), low priority to EP practice (62.1%), cardiovascular instability (58.6%) and lack of experience (58.6%). The most frequently indicated strategies to overcome these obstacles are to organize interdisciplinary briefings (86.2%), to avoid excluding patients from treatment without specific motivation (75.9%), to invest in staff training (75.9%), to use protocols and guidelines (58.6%). EP is not currently exploited to its full potential due to lack of funds, culture, experience, training and a hospital organization that limits the provision of effective patient care and efficient service to the National Health Service.
早期的物理治疗（EP）方案在重症监护病房（ICU）的危重病患者中已被证明是安全、可行和有效的。然而，尽管所有相关专业人员都认为这是综合护理的一个基本方面，但在大多数情况下，它们的应用不足或根本没有实施。本研究的主要目的是评估在罗马 ICU 工作的医生、护士和物理治疗师与 EP 相关的知识、看法和活动。还研究了其应用的障碍和可能的克服策略。该研究按照 CHERRIES 建议进行。在 Google 表单平台上创建了两个包含 29 个问题的问卷，并通过邮件发送给罗马公立医院或隶属于国家卫生服务的私立医院的所有 ICU。30 个（60%）联系的 ICU 做出了回应。物理治疗师在 76.7%的 ICU 中存在，并主要在白天（60.9%）进行活动，39.1%的情况下少于 3 小时，并且仅在请求专家建议后（65.2%）进行。仅在 4.3%的情况下，即使在周末也会保证该服务，但仅在请求后。所有接受采访的 29 名专业人员都认为 ICU 多学科团队中存在物理治疗师和实施 EP 方案都是必要的，支持该方案的积极影响。实施 EP 方案最常遇到的障碍是临床不稳定（69%）、EP 实践的优先级低（62.1%）、心血管不稳定（58.6%）和缺乏经验（58.6%）。克服这些障碍最常被提及的策略是组织跨学科简报（86.2%）、避免在没有具体动机的情况下将患者排除在治疗之外（75.9%）、投资于员工培训（75.9%）、使用协议和指南（58.6%）。由于缺乏资金、文化、经验、培训和限制向国家卫生服务提供有效患者护理和高效服务的医院组织，EP 目前没有得到充分利用。
