Predictive Factors for Physiotherapy Session Length at an Adult Intensive Care Unit: A Longitudinal Panel Study

Abstract

ObjectiveTo identify predictive factors for the length of physiotherapy sessions for adult intensive care unit (ICU) patients. DesignLongitudinal panel study. SettingICU of a secondary-care public teaching hospital, the University Hospital at the University of Sao Paulo, Brazil. ParticipantsMedical and surgical patients who received physiotherapy (N=181) assessed in 339 physiotherapy sessions.Interventions:Not applicable. Main Outcome MeasuresThe study investigator followed physiotherapists during their work shift and timed the physiotherapy session's length with a stopwatch. The association between session length and patient, physiotherapist, and service-related factors was evaluated by a mixed model. ResultsAssessed in this study were 339 physiotherapy sessions during 79 periods of observation that involved 181 patients and 19 physiotherapists. Median session length was 29 (interquartile range: 22.6-38.9) minutes; median number of patients assisted per physiotherapist per 6-hour shift was 5 (4-5). Physiotherapist's median age was 35 (26-39) years old, and median ICU experience was 13.0 (0.4-16.0) years. Patients were mostly older adults who were post surgery and had been at the ICU for 5 (2-9) days. Factors associated with physiotherapy session length (min) were the following: performing both motor- and respiratory-related physiotherapy procedures during the session (β=6.5; 95% confidence interval [CI], 3.8-9.2), altered chest x-ray (β=2.8; 95% CI, 0.3-5.3), ICU mobility scale (IMS) (β=1.2; 95% CI, 0.4-2.0), contraindication to any level of out-of-bed mobilization (β=–6.9; 95% CI, –10.5 to –3.3), afternoon shift (β=–4.0; 95% CI, –6.7 to –1.4), and Barthel index (β=–0.2; 95% CI, –0.3 to –0.1). ConclusionsThe factors associated with longer session lengths were performing both motor- and respiratory-related physiotherapy procedures during the session, altered chest x-ray, and the IMS. Contraindication to any level of out-of-bed mobilization and sessions performed during the afternoon shift (vs the morning shift) were associated with shorter session lengths.