Novel framework sets standard for ICU physiotherapists in Singapore

A recent study has identified 163 items of skills and knowledge that are necessary as a minimum standard for clinical practice for physiotherapists working in the intensive care unit (ICU) in Singapore.

“This framework may guide the content of the physiotherapy education curriculum on critical care rehabilitation and minimize variability in clinical practice across different healthcare institutions in Singapore,” said the researchers, led by Bernice X Lee of the Health and Social Sciences Cluster, Singapore Institute of Technology.

“The challenge now is to integrate this newly established framework into clinical teaching, position statements and performance management so as to reduce variability in clinical practice,” they added.

Lee and colleagues collated responses from ICU physiotherapists using a three-round modified Delphi questionnaire survey technique to establish a framework of the minimum standards for clinical practice. The questionnaire contained a total of 222 items, sorted into assessments, conditions, and treatments.

Responses to the items were as follows: “Yes, it is essential,” “No, it is not essential,” or “I am not sure.” Consensus was reached when 70 percent of the respondents ranked an item as essential or nonessential. Participants were registered physiotherapists who have worked in the ICU for at least 6 months in the last 12 months and are currently working in the ICU.

Twenty-three physiotherapists (median ICU experience 7.0 years) gave their consent and completed the initial survey, but only 13 completed all three rounds of questionnaires. [Proc Singap Healthc 2022;doi:10.1177/20101058221111577]

A total of 163 items were considered by physiotherapists as essential, while 21 were regarded as nonessential, and 38 did not reach consensus. The identified items varied from similar studies due to different scopes of physiotherapy practice and professional autonomy.

One of the items unanimously agreed upon by ICU physiotherapists was the knowledge of extra-ventricular drain since postneurosurgery patients are common across most ICUs in Singapore. This was also deemed essential in Japan, but not in Australia, New Zealand, and the UK.

Additionally, knowledge of actions and implications of pharmacological agents and delirium assessment were considered highly essential due to the critical role of ICU physiotherapists in expediting early mobilization in critically ill patients to prevent the onset or reduce the severity of ICU-acquired weakness. [Aust Crit Care 2015;28:177-182; Chest 2016;150:1129-1140; PLoS One 2019;14:e0223185]

“The emerging emphasis on improving health-related quality of life and functional outcomes of survivors of critical illness prompts effective physiotherapy treatment to boost patient outcomes in ICU,” the researchers said. “In such a complex setting like the ICU, this propels healthcare professionals to describe the minimum standards in clinical practice in order to provide optimal care for patients during their ICU stay.” [Physiotherapy 2015;101(Suppl 1):E15-E16]

Establishing minimum standards of competency could help in the creation of a standardized training framework for physiotherapists to function proficiently in the ICU. Such framework could lessen the variability in the quality of treatment, leading to improvements in patient outcomes, according to the researchers. [Crit Care Clin 2006;22:547-571]