Implementation of a protocol facilitates evidence-based physiotherapy practice in intensive care units

Objectives To compare the physiotherapy service provided when therapists' decisions are guided by an evidence-based protocol with usual care (i.e. patient management based on therapists' clinical decisions). Design Exploratory, controlled, pragmatic sequential time block clinical trial. Setting Level 3 surgical unit in a tertiary hospital in South Africa. Participants All patients admitted consecutively to the surgical unit over a 3-month period were allocated to usual or protocol care based on date of admission. Interventions Usual care was provided by clinicians from the hospital department, and non-specialised physiotherapists were appointed as locum tenens to provide evidence-based protocol care. Main outcome measures Patient waiting time, frequency of treatment sessions, tasks performed and adverse events. Results During protocol-care periods, treatment sessions were provided more frequently (P < 0.001) and with a shorter waiting period (P < 0.001). It was more likely for a rehabilitation management option to be included in a treatment session during protocol-care periods (odds ratio 2.34, 95% confidence interval 1.66 to 3.43; P < 0.001). No difference in the risk of an adverse event was found between protocol-care and usual-care periods (P = 0.34). Conclusions Physiotherapy services provided in intensive care units (ICUs) when the decisions of non-specialised therapists are guided by an evidence-based protocol are safe, differ from usual care, and reflect international consensus on current best evidence for physiotherapy in ICUs. Non-specialised therapists can use this protocol to provide evidence-based physiotherapy services to their patients. Future trials are needed to establish whether or not this will improve patient outcome. (c) 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.