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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
The way in which a physiotherapy service is structured can improve patient outcome from a surgical intensive care: A controlled clinical trial
Critical Care, Volume 16, No. 6, Article R230, Year 2012
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Description
Introduction: The physiological basis of physiotherapeutic interventions used in intensive care has been established. We must determine the optimal service approach that will result in improved patient outcome. The aim of this article is to report on the estimated effect of providing a physiotherapy service consisting of an exclusively allocated physiotherapist providing evidence-based/protocol care, compared with usual care on patient outcomes.Methods: An exploratory, controlled, pragmatic, sequential-time-block clinical trial was conducted in the surgical unit of a tertiary hospital in South Africa. Protocol care (3 weeks) and usual care (3 weeks) was provided consecutively for two 6-week intervention periods. Each intervention period was followed by a washout period. The physiotherapy care provided was based on the unit admission date. Data were analyzed with Statistica in consultation with a statistician. Where indicated, relative risks with 95% confidence intervals (CIs) are reported. Significant differences between groups or across time are reported at the alpha level of 0.05. All reported P values are two-sided.Results: Data of 193 admissions were analyzed. No difference was noted between the two patient groups at baseline. Patients admitted to the unit during protocol care were less likely to be intubated after unit admission (RR, 0.16; 95% CI, 0.07 to 0.71; RRR, 0.84; NNT, 5.02; P = 0.005) or to fail an extubation (RR, 0.23; 95% CI, 0.05 to 0.98; RRR, 0.77; NNT, 6.95; P = 0.04). The mean difference in the cumulative daily unit TISS-28 score during the two intervention periods was 1.99 (95% CI, 0.65 to 3.35) TISS-28 units (P = 0.04). Protocol-care patients were discharged from the hospital 4 days earlier than usual-care patients (P = 0.05). A tendency noted for more patients to reach independence in the transfers (P = 0.07) and mobility (P = 0.09) categories of the Barthel Index.Conclusions: A physiotherapy service approach that includes an exclusively allocated physiotherapist providing evidence-based/protocol care that addresses pulmonary dysfunction and promotes early mobility improves patient outcome. This could be a more cost-effective service approach to care than is usual care. This information can now be considered by administrators in the management of scarce physiotherapy resources and by researchers in the planning of a multicenter randomized controlled trial.Trial registration: PACTR201206000389290. © 2012 Hanekom et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Hanekom, Susan D.
South Africa, Stellenbosch
Stellenbosch University
Louw, Quinette Abigail
South Africa, Stellenbosch
Stellenbosch University
Coetzee, Andrè R.
South Africa, Stellenbosch
Stellenbosch University
Statistics
Citations: 43
Authors: 3
Affiliations: 1
Identifiers
Doi:
10.1186/cc11894
ISSN:
13648535
e-ISSN:
1466609X
Research Areas
Health System And Policy
Study Design
Randomised Control Trial
Exploratory Study
Study Approach
Quantitative
Study Locations
South Africa