Predictive Factors for Physiotherapy Session Length at an Adult Intensive Care Unit: A Longitudinal Panel Study

Abstract

Objective: To identify predictive factors for the length of physiotherapy sessions applied to adult intensive care unit (ICU) patients. Methods: This longitudinal panel study included physiotherapy sessions with medical and surgical patients at a teaching, secondary-care public hospital ICU. Sessions that were terminated before any procedure could be delivered were excluded. Study’s investigator followed the physiotherapist during the work shift and timed the physiotherapy session length with a stopwatch. Association between session length and patient, physiotherapist and service-related factors was evaluated by a mixed model. Results: 339 physiotherapy sessions during 79 periods of observation, involving 181 patients and 19 physiotherapists were assessed. Average (SD) session length was 31.5 (14.5) minutes; median number of patients assisted per physiotherapist per 6-hour shift was 5 (IQR: 4 to 5). Physiotherapist’s median age was 35 (26 to 39) years-old and median ICU experience was 13.0 (0.4 to 16.0) years. Patients were mostly elder, post-surgery, and had been at ICU for a median of 5 (2 to 9) days. Factors associated with longer physiotherapy session length were: admission due to neurological diagnosis (6-minute increase), altered chest x-ray (4-minute increase) and ICU mobility scale (1-minute increase); factors associated with shorter physiotherapy session length were: contraindication for out-of-bed mobilization (6-minute decrease), afternoon shift (versus morning shift) (4-minute decrease) and Barthel index (0.2-minute decrease). Conclusion: ICU admission due to neurological diagnosis, altered chest x-ray and ICU mobility scale were associated with longer physiotherapy session length; contraindication for out-of-bed mobilization and sessions performed in the afternoon shift (versus morning shift) were associated with shorter session length. Impact statement: These findings suggests that patients’ characteristics and service structure should be considered when making decision on human resource allocation in hospitals and call for evidence-based recommendations on the appropriate caseload of ICU physiotherapists to ensure high standard healthcare management.