Expert consensus on the minimum clinical standards of practice for Nigerian physiotherapists working in intensive care units: A modified Delphi study

Abstract

Background. Management of patients in intensive care units (ICUs) needs staff with a recommended level of expertise and experience owing to the life-threatening nature of illnesses, injuries and complications that these patients present with. There are no specific guidelines governing physiotherapy practice in ICUs in Nigeria. Hence, there is a need to have expert consensus on the minimum clinical standard of practice for physiotherapists working in ICUs as a first step to proposing/developing guidelines in the future. Objective. To assess the expert consensus on the minimum clinical standard of practice for physiotherapists working in ICUs in Nigeria. Method. Physiotherapists with working experience in Nigerian ICUs were purposively recruited into the present study using a modified Delphi technique. A questionnaire comprising 222 question items on the role of physiotherapy in critical care was adopted and administered to the participants over three rounds of Delphi procedure (online). Participants checked either 'essential' , 'not essential' or 'unsure' for each question item. For each question item to be considered 'essential' or 'not essential' , a consensus agreement ≥70% had to be met. Questions without consensus were further modified by providing definition or clarification and presented in subsequent rounds. Data were analysed descriptively. Results. We recruited 26 expert physiotherapists who consented to the study and completed the first round of the study. The majority of the physiotherapists (n=24) remained in the study after the third round. A total of 178 question items were adjudged to be 'essential' after the first round, and a further 15 and three additional items were subsequently adjudged to be as 'essential' after modifying the outstanding question items during the second and third rounds, respectively. No consensus was reached for 24 items. None of the question items were ranked as 'not essential' after all the rounds. Conclusion. Expert consensus was achieved for a substantial number of question items regarding knowledge and skills for assessment, condition and treatment items of the questionnaire by experienced critical care physiotherapists in Nigeria. Keywords. expert consensus; critical care physiotherapy; Delphi technique; standards of practice.

An important ‘step’ towards the standardisation of care offered by physiotherapists working in an ICU in a low- to middle-income country

“…In this issue of the AJTCCM, Idris et al . [8] have published the outcome of a Delphi survey attempting to address this lack of a critical care curriculum for physiotherapists. [9] A previously validated questionnaire comprising 222 question items on the role of physiotherapy in critical care developed by Skinner et al .…”

“…Idris et al . [8] should be commended on this well-written publication. The noteworthy points from this publication are that the practice of critical care medicine needs to be standardised across all disciplines working within the ICU environment.…”

“…[5][6][7] In Nigeria, there are no specific guidelines governing physiotherapy practice in ICUs. In this issue of the AJTCCM, Idris et al [8] have published the outcome of a Delphi survey attempting to address this lack of a critical care curriculum for physiotherapists. [9] A previously validated questionnaire comprising 222 question items on the role of physiotherapy in critical care developed by Skinner et al [10] was adopted and administered to participants over three rounds via an online Delphi survey.…”

International Survey of Cardiopulmonary Physical Therapy Management of Adult Intensive Care Unit Patients and the Impact of COVID-19

“…5,16,17 Guidelines and standards are just evolving for the educational profile and scope of practice requirements for physical therapy within ICUs in Australia, Japan, Nigeria, Singapore, the United Kingdom, and South Africa. [18][19][20][21][22][23][24] However, it is unclear whether hospital physical therapy or critical care departments utilize these guidelines. In addition, physical therapists in the United States may predominantly provide functional mobility training and therapeutic exercise in the ICU, whereas the acute respiratory care may be provided by other professions such as respiratory therapy.…”