title: Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations.
abstract: OBJECTIVE
  To develop evidence-based recommendations for effective and safe diagnostic assessment and intervention strategies for the physiotherapy treatment of patients in intensive care units.
  
  
  METHODS
  We used the EBRO method, as recommended by the 'Dutch Evidence Based Guideline Development Platform' to develop an 'evidence statement for physiotherapy in the intensive care unit'. This method consists of the identification of clinically relevant questions, followed by a systematic literature search, and summary of the evidence with final recommendations being moderated by feedback from experts.
  
  
  RESULTS
  Three relevant clinical domains were identified by experts: criteria to initiate treatment; measures to assess patients; evidence for effectiveness of treatments. In a systematic literature search, 129 relevant studies were identified and assessed for methodological quality and classified according to the level of evidence. The final evidence statement consisted of recommendations on eight absolute and four relative contra-indications to mobilization; a core set of nine specific instruments to assess impairments and activity restrictions; and six passive and four active effective interventions, with advice on (a) physiological measures to observe during treatment (with stopping criteria) and (b) what to record after the treatment.
  
  
  CONCLUSIONS
  These recommendations form a protocol for treating people in an intensive care unit, based on best available evidence in mid-2014.
authors: Department of Rehabilitation, University of Amsterdam, Amsterdam, The Netherlands.
authors: Juultje
authors: J
authors: Sommers
authors: Department of Rehabilitation, University of Amsterdam, Amsterdam, The Netherlands Education of Physiotherapy, University of Applied Sciences, Amsterdam, The Netherlands.
authors: Raoul H H
authors: RH
authors: Engelbert
authors: Department of Rehabilitation, University of Amsterdam, Amsterdam, The Netherlands.
authors: Daniela
authors: D
authors: Dettling-Ihnenfeldt
authors: Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
authors: Rik
authors: R
authors: Gosselink
authors: Department of Intensive Care, University of Amsterdam, Amsterdam, The Netherlands.
authors: Peter E
authors: PE
authors: Spronk
authors: Department of Rehabilitation, University of Amsterdam, Amsterdam, The Netherlands.
authors: Frans
authors: F
authors: Nollet
authors: Department of Rehabilitation, University of Amsterdam, Amsterdam, The Netherlands m.vanderschaaf@amc.uva.nl.
authors: Marike
authors: M
authors: van der Schaaf
mesh_terms: D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009426:Netherlands; D026741:Physical Therapy Modalities / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
keywords: Intensive care; clinimetrics; exercise; guideline; physiotherapy; rehabiliation; safety