Passive limb movements for patients in an intensive care unit: A survey of physiotherapy practice in Australia

Abstract

Purpose This study aimed to investigate physiotherapists' clinical practice regarding passive limb movements for adult patients in Australian intensive care units (ICUs). Materials and Methods A prospective survey using a purpose-designed questionnaire was mailed to the senior physiotherapist working in each Australian level 3 (tertiary) adult ICU. Results Of 65 questionnaires sent, 51 (78%) were returned. A minority of respondents (35%) undertook routine assessment of passive limb range of movement (ROM) for all ICU patients. Instead, most based the need for assessment on criteria such as length of stay, reason for admission, and medical history. A minority (14%) provided passive limb ROM exercises on a routine basis for all patients, instead most intervened only for high-risk patients or those with loss of ROM. The most frequently used interventions were manually applied passive limb ROM exercises, positioning, and mobilization, and the actual exercise prescription varied markedly. Respondents thought contracture was uncommon in ICU patients, was multifactorial in origin, and caused moderate problems. Personal experience and colleagues' advice were the factors most influencing clinical practice. Conclusions Although selective passive limb ROM assessment and intervention formed a part of most physiotherapists' clinical ICU practice, considerable variability was found in its application between respondents.