Abstract
BackgroundRehabilitative exercise for critically ill patients may have many benefits; however, it is unknown what intensive care unit (ICU) clinicians perceive to be important rationale for the implementation of rehabilitative exercise in critical care settings. ObjectiveTo identify which rationales for rehabilitative exercise interventions were perceived by ICU clinicians to be important and determine whether perceptions were consistent across nursing, medical and physiotherapy clinicians. MethodsA cross-sectional study was undertaken among clinicians (nursing, medical, physiotherapy) working in a mixed medical surgical ICU in an Australian metropolitan tertiary hospital. Participants completed a customised web-based questionnaire developed by a clinician working-group. The questionnaire consisted of 11 plausible rationales for commencing rehabilitative exercise in ICUs based on prior literature and their own clinical experiences grouped into 4 over-arching categories (musculoskeletal, respiratory, psychological and facilitation of discharge). Participants rated their perceived importance for each potential rationale on a 5-point Likert scale. ResultsParticipants (n=76) with a median (interquartile range) 4.8 (1.5, 15.5) years of experience working in ICUs completed the questionnaire. Responses were consistent across professional disciplines. Clinicians rated rehabilitative exercise as either ‘very much’ or ‘somewhat’ important for facilitating discharge (n=76, 100%), reducing muscle atrophy (n=76, 100%), increasing muscle strength (n=76, 100%), prevention of contractures (n=73, 96%), reducing the incidence of ICU acquired weakness (n=62, 82%), increasing oxygenation (n=71, 93%), facilitating weaning (n=72, 97%), reducing anxiety (n=60, 80%), reducing depression (n=64, 84%), reducing delirium (n=53, 70%), and increasing mental alertness (n=65, 87%). ConclusionsAny shortcoming in implementation of rehabilitation exercise is unlikely attributable to a lack of perceived importance by nursing, medical or physiotherapy clinicians who are the most likely clinicians to influence rehabilitation practices in ICUs. It is noteworthy that this study examined self-reported perceptions, not physiological or scientific legitimacy of rationales, or clinician behaviours in practice.
Highlights
Survivors of critical illness experience prolonged deficits in physical and psychological function that negatively impact on health-related quality of life that can persist for over 5 years.[1,2,3] Clinicians working within intensive care units (ICUs) are responsible for implementing interventions that are targeted to assisting critically ill patients to survive but to optimise function and healthrelated quality of life post hospital discharge
It is noteworthy that this study examined selfreported perceptions, not physiological or scientific legitimacy of rationales, or clinician behaviours in practice
More than half of the participants had previously worked in ICUs at other facilities, with 30% of participants having worked in ICUs in other countries adding to the likelihood that this finding could be generalised beyond this particular clinical setting
Summary
Survivors of critical illness experience prolonged deficits in physical and psychological function that negatively impact on health-related quality of life that can persist for over 5 years.[1,2,3] Clinicians working within intensive care units (ICUs) are responsible for implementing interventions that are targeted to assisting critically ill patients to survive but to optimise function and healthrelated quality of life post hospital discharge. Rehabilitative exercise for critically ill patients may have many benefits; it is unknown what intensive care unit (ICU) clinicians perceive to be important rationale for the implementation of rehabilitative exercise in critical care settings
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