Outcomes research in the ICU: An aid in defining the role of physiotherapy

Abstract

The economic reality of consumers, funders, and regulatory agencies demanding evidence regarding the quality of care patients are receiving in the intensive care unit (ICU) will have an effect on many of the routinely used practices in ICU, including physiotherapy. Outcomes research is a method that has been used to obtain evidence for the medical and respiratory management of patients in ICU. An overview of the literature was conducted to answer the following questions: 1. What is outcomes research? 2. Which outcomes should be measured in the adult critical care environment? 3. Which outcomes are physiotherapists currently including in research reports? Outcomes research is recognized by critical care specialists as a cost-effective method of determining what works in the real world. The value of physiologic measures is questioned, whereas the importance of patient centered, economic, and traditionally accepted outcome measures is increasingly being recognized. Most physiotherapy research reports still include physiologic measurements as the primary outcome of an intervention. Outcomes research provides researchers with the tools to define the role of the physiotherapist in the critical care environment. The outcomes measured must be relevant to patients, families, and funders.

The way in which a physiotherapy service is structured can improve patient outcome from a surgical intensive care: a controlled clinical trial

“…We are unaware of any standards regulating physiotherapists' qualifications in the ICU [2]. In addition, physiotherapy-sensitive outcomes are currently lacking in the ICU environment [19]. …”

Evaluation of a pilot programme on diagnostic thoracic ultrasound curriculum for acute care physiotherapists

“…In the critical care environment, physiotherapists routinely utilise combinations of clinical examination, lung auscultation and the interpretation of the chest radiograph findings to assist with clinical decision-making about the requirement for and response(s) to chest physiotherapy. 1 There is an increasing evidence base within critical care demonstrating the improved diagnostic accuracy and beneficial impact of diagnostic thoracic ultrasound (DTU) on clinical decision-making by intensivists for the detection of key pulmonary (interstitial syndrome, lung collapse/consolidation) and pleural pathologies (pneumothorax, pleural effusion). [2][3][4][5] Comparisons of the performance of the standard clinical assessment tools with DTU on clinical decision-making and impact on patient outcomes have yet to be fully investigated.…”

Impact of an intensive education programme of diagnostic lung and lower limb ultrasound on physiotherapist knowledge: A pilot study

“…In the acute care setting, physiotherapists routinely utilise combinations of clinical examination, lung auscultation and the interpretation of the chest radiograph findings to assist with clinical decision‐making about the requirement for and response(s) to chest physiotherapy . Thoracic ultrasound has greater diagnostic accuracy and beneficial impact on clinical decision‐making by physicians for the key pulmonary (interstitial syndrome, lung collapse/consolidation) and pleural pathologies (pneumothorax, pleural effusion) when compared to the portable chest radiograph .…”