title: The way in which a physiotherapy service is structured can improve patient outcome from a surgical intensive care: a controlled clinical trial.
abstract: BACKGROUND
  The physiological basis of physiotherapeutic interventions used in intensive care has been established. We must determine the optimal service approach that will result in improved patient outcome. The aim of this article is to report on the estimated effect of providing a physiotherapy service consisting of an exclusively allocated physiotherapist providing evidence-based/protocol care, compared with usual care on patient outcomes.
  
  
  METHODS
  An exploratory, controlled, pragmatic, sequential-time-block clinical trial was conducted in the surgical unit of a tertiary hospital in South Africa. Protocol care (3 weeks) and usual care (3 weeks) was provided consecutively for two 6-week intervention periods. Each intervention period was followed by a washout period. The physiotherapy care provided was based on the unit admission date. Data were analyzed with Statistica in consultation with a statistician. Where indicated, relative risks with 95% confidence intervals (CIs) are reported. Significant differences between groups or across time are reported at the alpha level of 0.05. All reported P values are two-sided.
  
  
  RESULTS
  Data of 193 admissions were analyzed. No difference was noted between the two patient groups at baseline. Patients admitted to the unit during protocol care were less likely to be intubated after unit admission (RR, 0.16; 95% CI, 0.07 to 0.71; RRR, 0.84; NNT, 5.02; P = 0.005) or to fail an extubation (RR, 0.23; 95% CI, 0.05 to 0.98; RRR, 0.77; NNT, 6.95; P = 0.04). The mean difference in the cumulative daily unit TISS-28 score during the two intervention periods was 1.99 (95% CI, 0.65 to 3.35) TISS-28 units (P = 0.04). Protocol-care patients were discharged from the hospital 4 days earlier than usual-care patients (P = 0.05). A tendency noted for more patients to reach independence in the transfers (P = 0.07) and mobility (P = 0.09) categories of the Barthel Index.
  
  
  CONCLUSIONS
  A physiotherapy service approach that includes an exclusively allocated physiotherapist providing evidence-based/protocol care that addresses pulmonary dysfunction and promotes early mobility improves patient outcome. This could be a more cost-effective service approach to care than is usual care. This information can now be considered by administrators in the management of scarce physiotherapy resources and by researchers in the planning of a multicenter randomized controlled trial.
  
  
  BACKGROUND
  PACTR201206000389290.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Hanekom
authors.forename: Quinette
authors.initials: Q
authors.lastname: Louw
authors.forename: Andre
authors.initials: A
authors.lastname: Coetzee
mesh_terms: D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods / Q000458:organization & administration*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000379:methods; D026761:Physical Therapy Specialty / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D016037:Single-Blind Method; D016896:Treatment Outcome