Minimal number of adverse physiological events during physiotherapy intervention

Background

There has been some controversy as to whether physiotherapy causes adverse physiological changes (APC) that could be harmful to intensive care patients.

Aims and method

A multicentre study in six Australian tertiary-level ICUs was performed to investigate the incidence of APC during physiotherapy in critically ill patients over a 3-month period, to benchmark this against studies that have recorded spontaneous APC, and to investigate whether there were any trends in patient category, demographic characteristics, type of intervention, or seniority of physiotherapist.

Results

There were 12,800 physiotherapy treatments completed, with 27 treatments resulting in adverse physiological changes (0.22%). This incidence was significantly lower than a previous study of APC (663 events/247 patients over a 24-hour period); that is, the incidence during physiotherapy was lower than during general ICU care. Significant factors were apparent, with a decrease in blood pressure or arrhythmia the major APC noted in patients on medium to high doses of inotropes/vasopressors, having unstable baseline hemodynamic values, previous cardiac comorbidities, receiving intervention consisting of positive pressure (two-sided Fisher's exact test P = 0.07), or right-side lying (two-sided Fisher's exact test P = 0.006).

Conclusion

This study has demonstrated that the overwhelming majority of physiotherapy treatments in intensive care are safe, but further factors should be investigated in controlled trials.