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Physical Therapist Treatment of Patients in the Neurological Intensive Care Unit : Description of Practice

Although studies have established the safety and feasibility of
physical therapy in the critical care setting, minimal information about physical
therapist practice in the neurological intensive care unit (NICU) is available.
This study describes physical therapists' treatment of people admitted
to a NICU. DESIGN: People admitted to the NICU with a diagnosis of subarachnoid
hemorrhage, subdural hematoma, intracranial hemorrhage, or trauma were
retrospectively studied. METHODS: Data on patient demographics, use of mechanical
ventilation, and intracranial pressure (ICP) monitoring were collected. For each
physical therapy session, the length of the session, the location (NICU or
post-NICU setting), and the presence of mechanical ventilation or ICP monitoring
were recorded. Data on safety parameters, including vital sign response, falls,
and dislodgement of lines, were collected. RESULTS: Over 1 year, 180 people were
admitted to the NICU; 86 were evaluated by a physical therapist, for a total of
293 physical therapy sessions in the NICU (n=132) or post-NICU setting (n=161).
Only one session (0.3%) was stopped, secondary to an increase in ICP. The first
physical therapy session occurred on NICU day 3.0 (25%-75% interquartile
range=2.0-6.0). Patients received a median of 3.4 sessions per week (25%-75%
interquartile range=1.8-5.9). Patients with mechanical ventilation received less
frequent physical therapy sessions than those without mechanical ventilation.
Patients with ICP monitoring received less frequent sessions than those without
ICP monitoring. However, after multivariate analysis, only the admission Glasgow
Coma Score was independently associated with physical therapy frequency in the
NICU. Patients were more likely to stand, transfer, and walk in the post-NICU
setting than in the NICU. LIMITATIONS: The results are limited by the
retrospective, single-center nature of the study.
There is inherent bias of
evaluating only those patients who had physical therapy, and therapists were
unable to completely adjust for the severity of illness of a given patient.
CONCLUSIONS: Physical therapy was performed safely in the NICU. Patients who
required invasive support received less frequent physical therapy.
CI - (c) 2015 American Physical Therapy Association.

Langue : ANGLAIS

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