Factors Influencing Physical Therapists’ Rehabilitation Prescription in the ICU: Semi-structured Interviews with Qualitative Analysis

Abstract

Purpose: Despite a plethora of studies on early rehabilitation, specific guidelines for rehabilitation prescription parameters are lacking. The objective of this study was to evaluate how physical therapists determine rehabilitation parameters such as initiation, frequency, intensity, duration, and type of interventions for patients in the ICU. Methods: Semi-structured interviews were conducted between April and August of 2021 using video conferencing software following a written interview guide. Purposive sampling was used among interested physical therapists to select those who work across a variety of ICU types with a range of years of ICU experience. We used thematic analysis to identify emerging themes using an inductive approach. Results: We interviewed 30 physical therapists in the USA with 14 (47%) and 16 (53%) having ≤5 years and >5 years of ICU clinical experience, respectively. Nine factors were identified as impacting all rehabilitation prescription parameters (e.g., medical appropriateness, diagnosis/prognosis, and alertness/sedation). For decisions about each parameter there were a set of factors identified: five for initiation (e.g., indication for physical therapy; ventilator settings/oxygen), four for frequency (e.g., baseline function; prior therapy session), three for intensity (e.g., patient appearance and subjective response), nine for duration (e.g., session preparation; quality of performance), and eight for type of intervention (e.g., progressive mobility; patient goals). Conclusion: Interviews examining rehabilitation parameters, revealed that physical therapists consider each of these simultaneously when making decisions about rehabilitation prescription. Furthermore, physical therapists appear to modify to the intervention not only based on patient progress, but by other external factors related to working in an ICU environment (e.g., equipment availability, interruptions for other medical procedures).