Rehabilitation and exercise prescription in Australian intensive care units

Abstract

Objectives To identify methods of exercise prescription by physiotherapists across Australian intensive care units (ICUs), including the most commonly used activities for both mechanically ventilated and spontaneously breathing patients; and to determine the outcome measures used for the evaluation of exercise intervention. Design Postal questionnaire. Setting One hundred and sixty-seven adult ICUs across all Australian states and territories. Participants Australian intensive care physiotherapists. Results In total, 126 questionnaires were returned from all states and territories of Australia except the Northern Territory. Almost half of the ICUs (49%, 20/41) that did not return a questionnaire lacked a permanent physiotherapy service. Seventy-eight percent (87/111) of respondents were senior staff, and 49% (54/111) of respondents had worked in ICUs for longer than 5 years. Almost all (94%, 104/111) physiotherapists prescribed exercise routinely for ICU patients, with active and active-assisted exercise techniques along with mobilisation being the most common activities utilised. Heart rate, oxygen saturation and respiratory rate were the most important factors used in modification of exercise prescription. Seventy-one percent (79/111) of respondents prescribed exercise routinely for mechanically ventilated patients, but altered the type of exercise prescription for these patients compared with spontaneously breathing patients. Only one-third (34%, 38/111) of physiotherapists used outcome measures routinely in ICU exercise prescription. Conclusions Although a large majority of ICU physiotherapists prescribed exercise routinely in ICU patients (including those on mechanical ventilation), practice varies widely throughout Australia. No validated, functional exercise outcome measures were used, highlighting that further research is required to enable adequate evaluation of exercise prescription and rehabilitation in ICUs.