Physiotherapy provision and practice: A EuropeAn Intensive CarE Unit (ICU) survey (PEAiCE) – A profile of ICU physiotherapy in Europe

Abstract

BackgroundPhysiotherapy is an essential component of respiratory management and mobilisation/rehabilitation for patients in the Intensive Care Unit (ICU). However, the current practices across Europe related to organisational models, referral pathways, or clinical techniques are not well-defined.PurposeTo examine physiotherapy provision and practice of respiratory management and mobilisation/rehabilitation for mechanically ventilated patients in European ICUs.MethodsAn online survey was developed, piloted and distributed in 11 languages via national coordinators, professional societies, and social media. The ICU physiotherapy leads, or in their absence, medical/nursing leaders from each ICU (one reply per ICU), completed the survey, which included information regarding ICU structure, physiotherapy provision, and current practice. Data were analysed descriptively.ResultsIn total, 845 responses from 33 countries were included, with the largest representation from Spain (12%), the United Kingdom (11%), and France (11%). Most respondents were physiotherapists (88%) working in university hospitals (69%) and caring primarily for adult ICU patients (87%). Less than half (41%) of physiotherapists were dedicated to ICU, but 91% of them had received some ICU-specific training. Physiotherapy is initiated upon a referral in 52% of ICUs. It usually includes routine respiratory assessment (80%) and both respiratory management and mobilisation/rehabilitation for mechanically ventilated patients (85%). The most common techniques included endotracheal suctioning (55%) and manually assisted cough (51%), with less frequent use of mechanical insufflation-exsufflation (20%) and saline instillation (18%). Mobilisation/rehabilitation was widely practised, with 76% of respondents reporting patients sitting at the edge of the bed, 69% standing, and 71% walking during their ICU stay.ConclusionsPhysiotherapy is a well-integrated part in European ICUs with physiotherapists providing both respiratory management and mobilisation/rehabilitation techniques, although heterogeneity persists in organisation, referral pathways and the use of specific techniques.Implications for Clinical PracticeThese results inform the development of future training and workforce planning, ultimately improving interprofessional ICU care across Europe, particularly in underrepresented areas.