Physical Therapist Practice in the ICU

Dan Malone just published (as first author) a paper in the journal Physical Therapy (Volume 95, Number 10) October 2015 titled “Physical Therapist Practice in the Intensive Care Unit: Results of a National Survey”.

The group sent out a survey to members of the Acute Care Section of the APTA addressing staffing, training, barriers and protocols to determine perceptions about providing rehabilitation in the ICU. The survey identified barriers to providing ICU rehabilitation as: insufficient staffing (the primary reason), lack of training, departmental prioritization policies and inadequate consultation criteria. Other barriers included sedation of the patients and scheduling conflicts related to the timing of medical procedures.

The type of training for this setting most frequently cited in this survey was “informal training” relying on mentorship and department-based competency requirements. The article mentioned that there are very few cardiovascular and pulmonary residencies and critical care fellowships currently credentialed by the American Board of Physical Therapy Residency and Fellowship Education to train this at this high level.

The survey group was given 6 hypothetical cases that might be encountered in this setting and was asked to recommend treatment frequencies for each diagnosis. Interestingly, none of these cases received recommendations for daily physical therapy. Although each of the cases was deemed to be “medically stable”,  ambulation was not recommended for the majority of patients. More therapists working in an academic setting were apt to recommend early mobilization/ambulation than those working in a community hospital setting. The conclusion drawn was that physical therapists working in acute care and ICU environments need further training to recognize the need for safe early mobilization.