Physical Therapy and Critical Care

Traditionally physical therapy has been most utilized in the rehabilitation of non-life threatening injuries due to an activity or occupation. However a need for physical therapy in critical care settings has emerged in recent years. This is due to several factors including a high ICU survival rate, patient demographics, and an overall shift in healthcare philosophy towards a collaborative team-approach to care delivery.

Factors supporting expanded physical therapy practice in an ICU environment

In examining the potential reasons for inclusion of physical therapists in a critical care environment it’s important to consider the ICU patient population. There is a significant amount of data available concerning the make-up of this group. Over 4 million people were admitted to the ICU in 2005, with an average age of 66.7. Patients who are beyond retirement age present distinct physical challenges and are especially vulnerable to long stays in the ICU. This combined with a relatively low ICU mortality rate of 8%, which has been steadily declining over the past twenty years means that hospitals have been forced to place greater emphasis on rehabilitative care for critical patients both during their stay, after transfer to a non-intensive floor, and following departure from facility.

A third factor is the increased focus on healthcare delivery as a team-based process primarily concerned with collaboration across providers to promote efficiency. Hospitals and clinics are beginning to implement systems that use a healthcare home model as a foundation for providing services to patients. The Affordable Care Act reinforces this shift in philosophy with projections for significant cost savings as a result of promoting preventative and rehabilitative strategies. This has the potential to make a significant impact in ICU spending as this area of care accounted for $81.7 billion and 13% of total hospital costs in 2005. The primary factor driving costs related to the ICU is patient length of stay. Utilizing physical therapists would appear to have the potential to reduce the average time that a patient remains in an intensive or critical care unit. A 2008 study published in the Journal of Critical Medicine found that providing mobility therapy to critically ill patients both reduced length of stay in the ICU, and overall number of days spent in the hospital.

Physical therapy programs adapting curriculum to meet critical care needs

As a way to better meet the increased need for physical therapists in critical care settings, institutions providing training in physical therapy have begun to develop curriculum to prepare graduates for potential work in the ICU. The University of Buffalo published a report in the American Journal of Physical Therapy which detailed its addition of an extensive critical care simulation with an initial involvement of 43 physical therapy students. Study coordinators measured student confidence in managing care for a patient in the ICU both prior to and following participation in the curriculum and simulation. Overall student confidence increased from ‘somewhat confident’ to ‘confident’ and associated response to the simulation was extremely positive. Similar simulation strategies using both electronic and live resources have been utilized by other physical therapy programs as detailed in the Cardiopulmonary Physical Therapy Journal.