van der Schaaf M1, Major-Helsloot M2, Hanekom S3, Patman S4
1Academic Medical Center, University of Amsterdam, ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Rehabilitation, Amsterdam, Netherlands, 2ACHIEVE - Centre of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, European School of Physiotherapy, Amsterdam, Netherlands, 3Faculty of Medicine and Health Sciences, Stellenbosch University, Physiotherapy, Stellenbosch, South Africa, 4School of Physiotherapy The University of Notre Dame, Fremantle, Australia
- To understand the impact of critical illness, ICU admission and the medical management of the patient on the daily functioning of the patient and their family.
- To understand the evidence based literature with respect to physiotherapy practice as part of the interdisciplinary care team for critically ill patients throughout the continuum of care.
- To share a newly developed educational tool and to discuss how undergraduate students and graduated physical therapists can be trained to be competent in the evidence based treatment of critically ill patients throughout all phases of recovery.
As the population ages and mortality from critical illness declines, the number of Intensive Care Unit (ICU) survivors is growing. Survivors of critical illness can undergo profound changes in their lives, with many having some form of impairment in one or more health domains resulting in restrictions in daily functioning, participation problems (employment) and decreased quality of life for months or years after hospital discharge. (1, 2) The term 'post-intensive care syndrome' (PICS) describes the new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond acute care hospitalization. (3)
PICS remains frequently unrecognized and, even when identified, may not be appropriately assessed and managed. (3, 4)
Physical impairments and restrictions as muscle weakness, joint stiffness and impaired exercise capacity are the most common symptoms of PICS. It is recognized that these impairments are related to the critical illness and the medical management of critically ill patients. With this, the physiotherapist plays a key role in the prevention and treatment of physical sequelae in critically ill patients.(5)
Evidence shows that early rehabilitation within the ICU is safe and effective, and improves functional status at hospital discharge. (6-10) Beyond this stage, standardized rehabilitation pathways do not exist for survivors of critical illness. However, recently an international consensus statement for physical rehabilitation for survivors of critical illness, in the post-clinical phase was developed (http://www.comet-initiative.org/studies/details/786).
In this focused symposium the impact of critical illness and ICU admission on daily functioning of the patient and their family will be discussed, along with the current evidence with respect to physiotherapy practice as part of the interdisciplinary care team for critically ill patients throughout the continuum of care. Additionally, a newly developed educational tool will be presented and discussion facilitated on how undergraduate students and graduated physical therapists can be trained to be competent in the treatment of critically ill patients.
Implications / Conclusions
The high prevalence and the severity of symptoms of PICS, necessitate appropriate interdisciplinary interventions. To improve functional independence and return to activities of daily living, a carefully planned interdisciplinary rehabilitation program should start in the ICU and continue through the different transitions of care form the ICU to the general ward and after hospital discharge. In addition, undergraduate students and graduated physical therapists should be trained to be competent in the treatment of critically ill patients.
- post intensive care syndrome
- interdisciplinary care
Van der Schaaf, Hanekom and Patman: not applicable
Major-Helsloot: PhD research is funded by the Netherlands Organization for Scientific Research (NWO)
Relevance to physical therapy globally
With the recognition of various long-term physical, cognitive and psychological impairments and restrictions in daily function in ICU survivors, it has been recognized that physical therapists play a key role in the interdisciplinary team during all phases of recovery. This symposium provides knowledge on physiotherapy interventions and interdisciplinary collaboration through the continuum of care and on the implementation of this knowledge in undergraduate and postgraduate educational programs.
Physiotherapists and physiotherapy educators interested in interdisciplinary care for critically ill patients during and after hospital stay and the implementation in physiotherapy education.
Programme subject to change