A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, in partial fulfilment of the requirements for the degree of Masters of Science in
Physiotherapy.
Johannesburg, 2015 / Patients admitted to the intensive care unit (ICU) require continuous monitoring and
care from all staff working in ICU; this includes doctors, nursing staff, physiotherapists, dieticians
and various other medical staff. Conventionally ICU was predominantly staffed by physicians and
nursing personnel, with other members of health care having a minor part to play in the patient’s
care whilst in ICU. Depending on the country, type of unit, amount of staff and level of training, the
physiotherapist may screen the patients to assess if they require physiotherapy and if so, what
intervention will be required; on the other hand, in some units the physiotherapist may rely on
referral from the doctors and administer the treatment requested by the doctor for the particular
patient. In 2000, Norrenberg and Vincent conducted a study to establish the profile of
physiotherapists working in ICU in Europe. Van Aswegen and Potterton (2005) adjusted the
questionnaire compiled by Norrenberg and Vincent (2000) to be more suitable for the South
African setting. A pilot study using this questionnaire was done to determine the scope of practice
of physiotherapists in ICU in South Africa. The content of the modified questionnaire used by Van
Aswegen and Potterton (2005) was not validated prior to its implementation and a sample of
convenience was used. Results reported from that survey were therefore only preliminary and no
additional surveys had been performed to date.
Objectives: The aim of this study was to establish the current scope of practice of
physiotherapists in ICU in South Africa. To determine if physiotherapists’ scope of practice in ICU
in South Africa has changed since the report published by Van Aswegen and Potterton (2005). To
compare South African physiotherapists’ scope of practice in ICU with that reported on an
international level.
Methodology: A pre-existing questionnaire used by Van Aswegen and Potterton (2005) was
content validated for this study. After consensus was reached on the final version of this
questionnaire, it was uploaded onto SurveyMonkey. Physiotherapists that worked in ICU in the
government sector, hospitals belonging to the Life, MediClinic and NetCare groups or that were
members of the Cardiopulmonary Physiotherapy Rehabilitation Group of the South African Society
of Physiotherapy were invited to participate in this study.
Results: A total of 319 questionnaires were sent out and 108 responses were received. The
combined response rate for this survey was 33.9%. An assessment technique that was performed
‘very often’ by respondents was an ICU chart assessment (n=90, 83.3%), auscultation (n=94, 81,
8%) and strength of cough effort (n=81, 75%). Assessment techniques that were ‘almost never’ or
‘never’ used included assessment of lung compliance (n=75; 69.4%), calculation for the presence
of hypoxemia (n=74; 68.5%) and patient readiness for weaning (n=63; 58.3%). Treatment
techniques performed by respondents ‘very often’ included manual chest clearance techniques
(n=101, 93.5%), mobilising a patient in bed (n=91, 84.3%), positioning a patient in bed (n=91,
84.3%), airway suctioning (n=89, 82.4%), mobilising a patient out of bed (n=84, 77.8%), deep
breathing exercises (n=83, 76.9%) and peripheral muscle strengthening exercises (n=79, 73.1%).
Treatment techniques that were ‘never’ or ‘almost never’ used included the flutter device (n=77,
71.3%), implementation and supervision of non-invasive ventilatory support (n=77, 71.3%) and
adjustment of mechanical ventilation settings for respiratory muscle training (n=76, 70.4%).
Physiotherapists working in the private sector made up 60.2% (n=65) of the respondents. An afterhours
physiotherapy service was provided to ICU patients by 78 (72.2%) of the respondents during
the week. One hundred and five (97.2%) of the respondents provided a physiotherapy service for
ICU patients over the weekend. When comparing the results of the current study to the studies by
Norrenberg and Vincent (2000) and Van Aswegen and Potterton (2005), there was a significant
difference (p < 0.05) in the usage of IPPB/NIPPV, weaning patients from MV, adjustment of MV
settings and IS between the studies. Results from the current study showed a significant difference
(p < 0.05) in the involvement of respondents in suctioning, extubation and adjustment of MV
settings compared to that reported by Norrenberg and Vincent (2000).
Conclusion: Physiotherapists in this study performed a multisystem assessment of their patient’s
which is important since physiotherapists are first line practitioners in South Africa.
Physiotherapists play an important role in treating and preventing respiratory and musculoskeletal
complications that occur in ICU. The results from this study showed that physiotherapists in South
Africa are treating their patient’s according to evidenced based practice but due to the high nonresponse
bias these results should be interpreted with caution. The results from this study can be
used to develop preliminary clinical practice guidelines for physiotherapists working in ICU in South
Africa.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/18681 |
| Date | 17 September 2015 |
| Creators | Lottering, Michele Anderson |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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