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VOLUME 20 , ISSUE 2 ( 2016 ) > List of Articles


Physiotherapy practice patterns in Intensive Care Units of Nepal: A multicenter survey

Sumana Baidya, Ranjeeta S. Acharya, Michel W. Coppieters

Keywords : Intensive Care Units, multicenter survey, Nepal, physiotherapy

Citation Information : Baidya S, Acharya RS, Coppieters MW. Physiotherapy practice patterns in Intensive Care Units of Nepal: A multicenter survey. Indian J Crit Care Med 2016; 20 (2):84-90.

DOI: 10.4103/0972-5229.175939

License: CC BY-ND 3.0

Published Online: 01-06-2013

Copyright Statement:  Copyright © 2016; The Author(s).


Context: As physiotherapy (PT) is a young profession in Nepal, there is a dearth of insight into the common practices of physiotherapists in critical care. Aims: To identify the availability of PT services in Intensive Care Units (ICUs) and articulate the common practices by physiotherapists in ICUs of Nepal. Settings and Design: All tertiary care hospitals across Nepal with ICU facility via an exploratory cross-sectional survey. Subjects and Methods: An existing questionnaire was distributed to all the physiotherapists currently working in ICUs of Nepal with 2 years of experience. The survey was sent via E-mail or given in person to 86 physiotherapists. Statistical Analysis Used: Descriptive and inferential statistics according to nature of data. Results: The response rate was 60% (n = 52). In the majority of hospitals (68%), PT service was provided only after a physician consultation, and few hospitals (13%) had established hospital criteria for PT in ICUs. Private hospitals (57.1%) were providing PT service in weekends compared to government hospitals (32.1%) (P = 0.17). The likelihood of routine PT involvement varied significantly with the clinical scenarios (highest 71.2% status cerebrovascular accident, lowest 3.8% myocardial infarction, P < 0.001). The most preferred PT treatment was chest PT (53.8%) and positioning (21.2%) while least preferred was therapeutic exercise (3.8%) irrespective of clinical scenarios. Conclusions: There is a lack of regular PT service during weekends in ICUs of Nepal. Most of the cases are treated by physiotherapists only after physician's referral. The preferred intervention seems to be limited only to chest PT and physiotherapists are not practicing therapeutic exercise and functional mobility training to a great extent.

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  1. Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, et al. Physiotherapy for adult patients with critical illness: Recommendations of the European respiratory society and European society of intensive care medicine task force on physiotherapy for critically ill patients. Intensive Care Med 2008;34:1188-99.
  2. Gosselink R, Clerckx B, Robbeets C, Vanhullebusch T, Vanpee G, Segers J. Physiotherapy in the intensive care unit. Neth J Crit Care 2011;15:66-75.
  3. Moseley AM, Herbert RD, Sherrington C, Maher CG. Evidence for physiotherapy practice: A survey of the physiotherapy evidence database (PEDro). Aust J Physiother 2002;48:43-9.
  4. Stiller K. Physiotherapy in intensive care: Towards an evidence-based practice. Chest 2000;118:1801-13.
  5. Stiller K. Physiotherapy in intensive care: An updated systematic review. Chest 2013;144:825-47.
  6. Schweickert WD, Kress JP. Implementing early mobilization interventions in mechanically ventilated patients in the ICU. Chest 2011;140:1612-7.
  7. Thomas AJ. Physiotherapy led early rehabilitation of the patient with critical illness. Phys Ther Rev 2011;16:46-57.
  8. Hodgin KE, Nordon-Craft A, McFann KK, Mealer ML, Moss M. Physical therapy utilization in intensive care units: Results from a national survey. Crit Care Med 2009;37:561-6.
  9. Lunardi N, Bryant M, Smith K, Lowson S. Early mobilization in critically ill patients. ICU Dir 2012;3:17-20.
  10. Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care 2014 4;18:658.
  11. Owoeye IO. The Advances of Physiotherapy: University of Lagos; 2002. Available from: [Last accessed 2015 Jul 09].
  12. Nydahl P, Ruhl AP, Bartoszek G, Dubb R, Filipovic S, Flohr HJ, et al. Early mobilization of mechanically ventilated patients: A 1-day point-prevalence study in Germany. Crit Care Med 2014;42:1178-86.
  13. Berney SC, Harrold M, Webb SA, Seppelt I, Patman S, Thomas PJ, et al. Intensive care unit mobility practices in Australia and New Zealand: A point prevalence study. Crit Care Resusc 2013;15:260-5.
  14. Li Z, Peng X, Zhu B, Zhang Y, Xi X. Active mobilization for mechanically ventilated patients: A systematic review. Arch Phys Med Rehabil 2013;94:551-61.
  15. Adler J, Malone D. Early mobilization in the intensive care unit: A systematic review. Cardiopulm Phys Ther J 2012;23:5-13.
  16. Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU: A systematic review and meta-analysis. Crit Care Med 2013;41:1543-54.
  17. Bhat A, Chakravarthy K, Rao BK. Chest physiotherapy techniques in neurological intensive care units of India: A survey. Indian J Crit Care Med 2014;18:363-8.
  18. Chaboyer W, Gass E, Foster M. Patterns of chest physiotherapy in Australian Intensive Care Units. J Crit Care 2004;19:145-51.
  19. Norrenberg M, Vincent JL. A profile of European intensive care unit physiotherapists. European society of intensive care medicine. Intensive Care Med 2000;26:988-94.
  20. Kumar JA, Maiya AG, Pereira D. Role of physiotherapists in intensive care units of India: A multicenter survey. Indian J Crit Care Med 2007;11:198-203.
  21. Berney S, Denehy L, Pretto J. Head-down tilt and manual hyperinflation enhance sputum clearance in patients who are intubated and ventilated. Aust J Physiother 2004;50:9-14.
  22. Hodgson C, Denehy L, Ntoumenopoulos G, Santamaria J, Carroll S. An investigation of the early effects of manual lung hyperinflation in critically ill patients. Anaesth Intensive Care 2000;28:255-61.
  23. Jones AY, Hutchinson RC, Oh TE. Effects of bagging and percussion on total static compliance of the respiratory system. Physiotherapy 1992;78:661-6.
  24. Maa SH, Hung TJ, Hsu KH, Hsieh YI, Wang KY, Wang CH, et al. Manual hyperinflation improves alveolar recruitment in difficult-to-wean patients. Chest 2005;128:2714-21.
  25. Ntoumenopoulos G, Gild A, Cooper DJ. The effect of manual lung hyperinflation and postural drainage on pulmonary complications in mechanically ventilated trauma patients. Anaesth Intensive Care 1998;26:492-6.
  26. Stiller K, Geake T, Taylor J, Grant R, Hall B. Acute lobar atelectasis. A comparison of two chest physiotherapy regimens. Chest 1990;98:1336-40.
  27. Berney S, Denehy L. A comparison of the effects of manual and ventilator hyperinflation on static lung compliance and sputum production in intubated and ventilated intensive care patients. Physiother Res Int 2002;7:100-8.
  28. Choi JS, Jones AY. Effects of manual hyperinflation and suctioning in respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia. Aust J Physiother 2005;51:25-30.
  29. Patman S, Jenkins S, Stiller K. Manual hyperinflation – Effects on respiratory parameters. Physiother Res Int 2000;5:157-71.
  30. Ntoumenopoulos G, Presneill JJ, McElholum M, Cade JF. Chest physiotherapy for the prevention of ventilator-associated pneumonia. Intensive Care Med 2002;28:850-6.
  31. Thomas PJ, Paratz JD, Stanton WR, Deans R, Lipman J. Positioning practices for ventilated intensive care patients: Current practice, indications and contraindications. Aust Crit Care 2006;19:122-6, 128, 130-2.
  32. King J, Crowe J. Mobilization practices in Canadian critical care units. Physiother Can 1998;50:206-11.
  33. Skinner EH, Berney S, Warrillow S, Denehy L. Rehabilitation and exercise prescription in Australian intensive care units. Physiotherapy 2008;94:220-9.
  34. Shrestha R, Bajracharya PV. A survey of adult intensive care units in Kathmandu valley. Postgrad Med J NAMS 2011;11:1-7.
  35. Maffiuletti NA, Roig M, Karatzanos E, Nanas S. Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: A systematic review. BMC Med 2013;11:137.
  36. Routsi C, Gerovasili V, Vasileiadis I, Karatzanos E, Pitsolis T, Tripodaki E, et al. Electrical muscle stimulation prevents critical illness polyneuromyopathy: A randomized parallel intervention trial. Crit Care 2010;14:R74.
  37. Rodriguez PO, Setten M, Maskin LP, Bonelli I, Vidomlansky SR, Attie S, et al. Muscle weakness in septic patients requiring mechanical ventilation: Protective effect of transcutaneous neuromuscular electrical stimulation. J Crit Care 2012;27:319.e1-8.
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