Critical illness can be iatrogenic, arising from the lifesaving measures undertaken during admission to critical care. Early mobilization (EM) of patients receiving intensive care unit (ICU)-level care may reduce the possible iatrogenic effects of critical care following cardiac surgery. While evidence supports the safety and efficacy of physiotherapy in the medical-surgical ICU, few studies have included critically ill patients with complicated, prolonged post-operative recoveries despite the worldwide frequency of cardiac surgery. This has resulted in a lack of clinical practice guidelines or systematic reviews to help guide critical care physiotherapy practice in post-operative cardiac surgery. In-bed cycling is a modality to initiate EM. However, its safety and feasibility have yet to be established in the critically ill cardiac surgery population. There is also a paucity of qualitative research investigating clinicians’ attitudes and beliefs about in-bed cycling as an acceptable rehabilitation modality.
Purposes:
(1) To describe current physiotherapy practice for critically ill adult patients requiring prolonged admissions to ICU post cardiac surgery in Ontario via an electronic, self-administered survey;
(2) To investigate the feasibility of in-bed cycling in a pilot study in a sample of critically ill cardiac surgery patients in Hamilton, Ontario;
(3) To explore primary frontline clinicians’ experiences and impressions of their involvement with in-bed cycling in the cardiac surgical ICU via an interpretive description qualitative interview study.
With adequate physiotherapy staffing, in-bed cycling was found to be safe and feasible with few adverse events occurring during cycling. With an 80% response rate, our survey results suggest that Ontario critical care physiotherapists provide a variety of interventions ranging from chest physiotherapy to functional mobility. Clinicians supported the use of in-bed cycling. Concerns included how to identify appropriate patients and timing of the intervention. This thesis built upon the current critical care research by increasing the presence of the cardiac surgery population in the rehabilitation literature. / Thesis / Doctor of Rehabilitation (RhD) / Early exercise can help patients rehabilitate after a critical illness. No current research exists examining the role of in-bed cycling with patients who become critically ill after heart surgery (so called “off-track”). The thesis goals were: (1) to conduct a survey of Ontario ICU physiotherapists to understand their role treating off-track patients with a complicated post-operative recovery; (2) to determine if cycling is safe and feasible with sick patients after heart surgery in the intensive care unit (ICU); and (3) to interview staff in the Hamilton heart surgery ICU to understand their experiences with in-bed cycling. Ontario physiotherapists provide a multitude of interventions in the heart surgery ICU. Cycling was found to be safe and feasible with adequate physiotherapy staffing. Intensive care unit staff supported in-bed cycling but were concerned about choosing the right patients and how best to time its introduction. With limited evidence around physiotherapy in the heart surgery ICU, larger studies are needed.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/26480 |
| Date | January 2021 |
| Creators | Newman, Anastasia |
| Contributors | Solomon, Patricia, Rehabilitation Science |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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