Patient perceptions of ICU physiotherapy: ‘Your body needs to go somewhere to be recharged ... ’
Article Sidebar
Main Article Content
Abstract
Background. Patient satisfaction is an essential concept to consider for the improvement of quality care in healthcare centres and hospitals and has been linked to increased patient compliance with treatment plans, better patient safety and improved clinical outcomes.
Objective. As part of a before-and-after clinical trial aimed to investigate the implementation of an evidence-based and -validated physiotherapy protocol within a surgical intensive care unit (ICU), we decided to include the patient perception of physiotherapy received in the intervention unit.
Method. A nested, exploratory, descriptive, qualitative study design was adopted. Purposively selected adult patients discharged from ICU during the implementation phase of the trial were interviewed.
Results. Eighteen patients (10 male) with a median age of 44 years and median ICU length of stay (LOS) of six days were included. Three themes and nine categories emerged: (i) linking therapy to clinical outcome (patient expectations and understanding; physiotherapy activities and the implication of mobilisation; physiotherapy benefits and progression); (ii) the importance of developing a trusting relationship (physiotherapy value; safety; continuity of care); and (iii) communication (satisfaction; interactions and patient perception and experience of physiotherapy).
Conclusion. While confirming barriers to early mobility, patients perceived participation in mobility activities as a marked jolt in their journey to recovery following a critical incident. Effective communication and preservation of trust between physiotherapist and patient are essential for understanding expectations and can facilitate improved outcomes. Clinicians can use the information when managing critically ill patients. Including patient-reported outcomes to measure physiotherapy interventions used in the ICU is feasible and can inform the development of such outcomes.
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors retain copyright and grant the journal right of first publication.
How to Cite
References
Hojat M, Louis DZ, Maxwell K, Markham FW, Wender RC, Gonnella JS. A brief instrument to measure patients’ overall satisfaction with primary care physicians. Fam Med 2011;43(6):412-417. 2. Hush JM, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care:
A systematic review. Phys Ther 2011;91(1):25-36. https://doi.org/10.2522/ptj.20100061
Sun BC, Adams J, Orav EJ, Rucker DW, Brennan TA, Burstin HR. Determinants of patient satisfaction and willingness to return with emergency care. Ann Emerg Med 2000;35(5):426-434. 4. Prakash B. Patient satisfaction. J Cutan Aesthet Surg 2010;3(3):151-155. https://doi.
org/10.4103/0974-2077.74491
Anhang Price R, Elliott MN, Zaslavsky AM, et al. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev 2014;71(5):522-554. https://doi. org/10.1177/1077558714541480
Brownson RC, Baker EA, Leet TL, Gillespie KN. Evidence-based Public Health. New York: Oxford University Press; 2003.
Akobeng AK. Evidence in practice. Arch Dis Child 2005;90(8):849-852. https://doi.org/10.1136/ adc.2004.058248
Holland C, Cason CL, Prater LR. Patients’ recollections of critical care. Dimens Crit Care Nurs 1997;16(3):132-141. https://doi..org/10.1097/00003465-199705000-00003
Dinglas VD, Faraone LN, Needham DM. Understanding patient-important outcomes after critical illness: A synthesis of recent qualitative, empirical, and consensus-related studies. Curr Opin Crit Care 2018;24(5):401-409. https://doi.org/10.1097/MCC.0000000000000533
So HM, Chan DS. Perception of stressors by patients and nurses of critical care units in Hong Kong. Int J Nurs Stud 2004;41(1):77-84. https://doi.org/10.1016/s0020-7489(03)00082-8
Cutler LR, Hayter M, Ryan T. A critical review and synthesis of qualitative research on patient experiences of critical illness. Intensive Crit Care Nurs 2013;29(3):147-157. https://doi. org/10.1016/j.iccn.2012.12.001
Boev C. The relationship between nurses’ perception of work environment and patient satisfaction in adult critical care. J Nurs Scholarsh 2012;44(4):368-375. https://doi.org/10.1111/ j.1547-5069.2012.01466.x
Stiller K, Wiles L. Patient satisfaction with the physiotherapy service in an intensive care unit. S Afr J Physiother 2008;64(1),43-46. https://doi.org/10.4102/sajp.v64i1.100
Johannessen G, Eikeland A, Stubberud DG, Fagerstöm L. A descriptive study of patient satisfaction and the structural factors of Norwegian intensive care nursing. Intensive Crit Care Nurs 2011;27(5):281-289. https://doi.org/10.1016/j.iccn.2011.07.004
Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: A randomised controlled trial. Lancet 2009;373(9678):1874-1882. https://doi.org/10.1016/S0140-6736(09)60658-9
Gosselink R, Needham D, Hermans G. ICU-based rehabilitation and its appropriate metrics. Curr Opin Crit Care 2012;18(5):533-539. https://doi.org/10.1097/MCC.0b013e328357f022
Stiller K. Physiotherapy in intensive care: An updated systematic review. Chest 2013;144(3):825- 847. https://doi.org/10.1378/chest.12-2930
Dafoe S, Stiller K, Chapman M. Staff perceptions of the barriers to mobilizing ICU patients. Internet J Allied Health Sci Pract 2015;13(2). https://doi.org/10.46743/1540-580X/2015.1526
Gosselink R, Clerckx B, Robbeets C, Vanhullebusch T, Vanpee G, Segers J. Physiotherapy in the
intensive care unit. Netherlands J Crit Care 2011;15(2):66-75.
Watanabe S, Hirasawa J, Naito Y, et al. Association between the early mobilisation of mechanically ventilated patients and independence in activities of daily living at hospital discharge. Sci Rep 2023;13(1):4265. https://doi.org/10.1038/s41598-023-31459-1
Wang YT, Lang JK, Haines KJ, Skinner EH, Haines TP. Physical rehabilitation in the ICU: A systematic review and meta-analysis. Crit Care Med 2022;50(3):375-388. https://doi.org/10.1097/ CCM.0000000000005285
Ambrosino N, Janah N, Vagheggini G. Physiotherapy in critically ill patients. Rev Port Pneumol 2011;17(6):283-288. https://doi.org/10.1016/j.rppneu.2011.06.004
Zhang L, Hu W, Cai Z, et al. Early mobilisation of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PLoS One 2019;14(10):e0223185. https:/doi.org/10.1371/ journal.pone.0223185
Hanekom, S. Physiotherapy in the intensive care unit. South Afr J Crit Care (Online) 2016;32(1), 3-4. https://doi.org/10.7196/sajcc.2016.v32i1.293
Hanekom SD, Faure M, Coetzee A. Outcomes research in the ICU: An aid in defining the role of physiotherapy. Physiother Theory Pract 2007;23(3):125-135. https://doi. org/10.1080/09593980701209204
Latour JM, Kentish-Barnes N, Jacques T, Wysocki M, Azoulay E, Metaxa V. Improving the intensive care experience from the perspectives of different stakeholders. Crit Care 2022;26(1):218. https:// doi.org/10.1186/s13054-022-04094-x
Del Baño-Aledo ME, Medina-Mirapeix F, Escolar-Reina P, Montilla-Herrador J, Collins SM. Relevant patient perceptions and experiences for evaluating quality of interaction with physiotherapists during outpatient rehabilitation: A qualitative study. Physiother 2014;100(1):73- 79. https://doi.org/10.1016/j.physio.2013.05.001
Hanekom S, Louw QA, Coetzee AR. The implementation and evaluation of a best practice physiotherapy protocol in a surgical ICU [unpublished dissertation]. Stellenbosch: Stellenbosch University; 2010.
Hanekom SD, Louw Q, Coetzee A. The way in which a physiotherapy service is structured can improve patient outcome from a surgical intensive care: A controlled clinical trial. Crit Care 2012;16(6):R230. https://doi.org/10.1186/cc11894
Hanekom S, Gosselink R, Dean E, et al. The development of a clinical management algorithm for early physical activity and mobilisation of critically ill patients: Synthesis of evidence and expert opinion and its translation into practice. Clin Rehabil 2011;25(9):771-787. https://doi. org/10.1177/0269215510397677
Hanekom S, Louw QA, Coetzee AR. Implementation of a protocol facilitates evidence- based physiotherapy practice in intensive care units. Physiother 2013;99(2):139-145.https://doi. org/10.1016/j.physio.2012.05.005
Hunt JM. The cardiac surgical patient’s expectations and experiences of nursing care in the intensive care unit. Aust Crit Care 1999;12(2):47-53. https://doi.org/10.1016/s1036- 7314(99)70535-7
Hanekom S, Coetzee A, Faure M. Outcome evaluation of a South African ICU – a baseline study. South Afr J Crit 2006;22(1):14-20. https://doi.org/10.7196/SAJCC.3
De Jonghe B, Sharshar T, Lefaucheur JP, et al. Paresis acquired in the intensive care unit: A prospective multicenter study. JAMA 2002;288(22):2859-2867. https://doi.org/10.1001/ jama.288.22.2859
van Nes M, Karachi F, Hanekom S. Patient perceptions of ICU care: A scoping review. South Afr J Crit Care 2014;31(3):24-28. https://doi.org/10.7196/SAJCC.237
Maree K, editor. First steps in research. 9th ed. Pretoria: Van Schaik Publishers; 2011.
Ten Hoorn S, Elbers PW, Girbes AR, Tuinman PR. Communicating with conscious and mechanically ventilated critically ill patients: A systematic review. Crit Care 2016;20(1):333. https://doi.org/10.1186/s13054-016-1483-2
Ashworth P. The needs of the critically ill patient. Intensive Care Nurs 1987;3(4):182-190. https://
doi.org/10.1016/0266-612X(87)90077-0
Novaes MA, Knobel E, Karam CH, Andreoli PB, Laselva C. A simple intervention to improve satisfaction in patients and relatives. Intensive Care Med 2001;27(5):937. https://doi.org/10.1007/ s001340100910
Clark PA. Intensive care patients’ evaluations of the informed consent process. Dimens Crit Care Nurs 2007;26(5):207-226. https://doi.org/10.1097/01.DCC.0000286826.57603.6a
Modra LJ, Hart GK, Hilton A, Moore S. Informed consent in the intensive care unit: The experiences and expectations of patients and their families. Crit Care Resusc 2014;16(4):262-268.
Hafsteindóttir TB. Patient’s experiences of communication during the respirator treatment period.
Intensive Crit Care Nurs 1996;12(5):261-271. https://doi.org/10.1016/s0964-3397(96)80693-8
Al-Yahyai ANS, Arulappan J, Matua GA, et al. Communicating to non-speaking critically ill patients: Augmentative and alternative communication technique as an essential strategy. SAGE Open Nurs 2021;7:23779608211015234. https://doi.org/10.1177/23779608211015234
Brennan N, Barnes R, Calnan M, Corrigan O, Dieppe P, Entwistle V. Trust in the health-care provider-patient relationship: A systematic mapping review of the evidence base. Int J Qual Health
Care 2013;25(6):682-688. https://doi.org/10.1093/intqhc/mzt063
Hall AM, Ferreira PH, Maher CG, Latimer J, Ferreira ML. The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: A systematic review. Phys Ther 2010;90(8):1099-1110. https://doi.org/10.2522/ptj.20090245
Birkhäuer J, Gaab J, Kossowsky J, et al. Trust in the health care professional and health outcome: A meta-analysis. PLoS One 2017;12(2):e0170988.https://doi.org/10.1371/journal.pone.0170988
Lemmers AL, van der Voort PHJ. Trust in intensive care patients, family, and healthcare professionals: The development of a conceptual framework followed by a case study. Healthcare (Basel) 2021;9(2):208. https://doi.org/10.3390/healthcare9020208
Ariba AJ, Thanni LO, Adebayo EO. Patients’ perception of quality of emergency care in a Nigerian teaching hospital: The influence of patient-provider interactions. Niger Postgrad Med J 2007;14(4):296-301.
Goldwag R, Berg A, Yuval D, Benbassat J. Predictors of patient dissatisfaction with emergency care. Isr Med Assoc J 2002;4(8):603-606.
Romero-García M, de la Cueva-Ariza L, Jover-Sancho C, et al. La percepción del paciente crítico sobre los cuidados enfermeros: Una aproximación al concepto de satisfacción [Perception of the critical patient on nursing cares: An approach to the concept of satisfaction]. Enferm Intensiva 2013;24(2):51-62. https://doi.org/10.1016/j.enfi.2012.09.003