title: Implementation of a protocol facilitates evidence-based physiotherapy practice in intensive care units.
abstract: OBJECTIVE
  To compare the physiotherapy service provided when therapists' decisions are guided by an evidence-based protocol with usual care (i.e. patient management based on therapists' clinical decisions).
  
  
  METHODS
  Exploratory, controlled, pragmatic sequential time block clinical trial.
  
  
  METHODS
  Level 3 surgical unit in a tertiary hospital in South Africa.
  
  
  METHODS
  All patients admitted consecutively to the surgical unit over a 3-month period were allocated to usual or protocol care based on date of admission.
  
  
  METHODS
  Usual care was provided by clinicians from the hospital department, and non-specialised physiotherapists were appointed as locum tenens to provide evidence-based protocol care.
  
  
  METHODS
  Patient waiting time, frequency of treatment sessions, tasks performed and adverse events.
  
  
  RESULTS
  During protocol-care periods, treatment sessions were provided more frequently (P<0.001) and with a shorter waiting period (P<0.001). It was more likely for a rehabilitation management option to be included in a treatment session during protocol-care periods (odds ratio 2.34, 95% confidence interval 1.66 to 3.43; P<0.001). No difference in the risk of an adverse event was found between protocol-care and usual-care periods (P=0.34).
  
  
  CONCLUSIONS
  Physiotherapy services provided in intensive care units (ICUs) when the decisions of non-specialised therapists are guided by an evidence-based protocol are safe, differ from usual care, and reflect international consensus on current best evidence for physiotherapy in ICUs. Non-specialised therapists can use this protocol to provide evidence-based physiotherapy services to their patients. Future trials are needed to establish whether or not this will improve patient outcome.
authors.affiliation: Department of Interdisciplinary Health Sciences, Stellenbosch University, Stellenbosch, South Africa. sdh@sun.ac.za
authors.forename: S
authors.initials: S
authors.lastname: Hanekom
authors.forename: Q A
authors.initials: QA
authors.lastname: Louw
authors.forename: A R
authors.initials: AR
authors.lastname: Coetzee
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D016638:Critical Illness / Q000451:nursing / Q000628:therapy*; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D017063:Outcome Assessment, Health Care; D026761:Physical Therapy Specialty / Q000458:organization & administration*; D015397:Program Evaluation; D013019:South Africa; D062606:Tertiary Care Centers / Q000458:organization & administration