Clinicians' perceptions of rationales for rehabilitative exercise in a critical care setting: A cross-sectional study.
BACKGROUND
Rehabilitative exercise for critically ill patients may have many benefits; however, it is unknown what intensive care unit (ICU) clinicians perceive to be important rationale for the implementation of rehabilitative exercise in critical care settings.


OBJECTIVE
To identify which rationales for rehabilitative exercise interventions were perceived by ICU clinicians to be important and determine whether perceptions were consistent across nursing, medical and physiotherapy clinicians.


METHODS
A cross-sectional study was undertaken among clinicians (nursing, medical, physiotherapy) working in a mixed medical surgical ICU in an Australian metropolitan tertiary hospital. Participants completed a customised web-based questionnaire developed by a clinician working-group. The questionnaire consisted of 11 plausible rationales for commencing rehabilitative exercise in ICUs based on prior literature and their own clinical experiences grouped into 4 over-arching categories (musculoskeletal, respiratory, psychological and facilitation of discharge). Participants rated their perceived importance for each potential rationale on a 5-point Likert scale.


RESULTS
Participants (n=76) with a median (interquartile range) 4.8 (1.5, 15.5) years of experience working in ICUs completed the questionnaire. Responses were consistent across professional disciplines. Clinicians rated rehabilitative exercise as either 'very much' or 'somewhat' important for facilitating discharge (n=76, 100%), reducing muscle atrophy (n=76, 100%), increasing muscle strength (n=76, 100%), prevention of contractures (n=73, 96%), reducing the incidence of ICU acquired weakness (n=62, 82%), increasing oxygenation (n=71, 93%), facilitating weaning (n=72, 97%), reducing anxiety (n=60, 80%), reducing depression (n=64, 84%), reducing delirium (n=53, 70%), and increasing mental alertness (n=65, 87%).


CONCLUSIONS
Any shortcoming in implementation of rehabilitation exercise is unlikely attributable to a lack of perceived importance by nursing, medical or physiotherapy clinicians who are the most likely clinicians to influence rehabilitation practices in ICUs. It is noteworthy that this study examined self-reported perceptions, not physiological or scientific legitimacy of rationales, or clinician behaviours in practice.
Intensive Care Unit and Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia; School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. Electronic address: marc.nickels@health.qld.gov.au.
Marc
M
Nickels
Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Australia; NHMRC Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Health Sciences, City University London, London, United Kingdom.
Leanne M
LM
Aitken
Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia.
James
J
Walsham
Intensive Care Unit and Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia.
Lisa
L
Watson
School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia.
Steven
S
McPhail
D003422:Critical Care; D016638:Critical Illness / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D005081:Exercise Therapy; D006801:Humans; D007362:Intensive Care Units; D008505:Medical Staff, Hospital; D011795:Surveys and Questionnaires
Critical care; Critical illness; Exercise; Exercise therapy; Intensive care; Intensive care units; Length of stay; Questionnaires; Rehabilitation