Practice patterns of physiotherapists in neonatal intensive care units: A national survey

Effect of Chest Physiotherapy on Improving Pulmonary Function in Dealing With Congenital Heart Disease and Lung Collapse: A Case Report

Patent ductus arteriosus (PDA) is a condition in which the ductus arteriosus fails to close after birth. We present the case of a three-month-old female infant admitted to a tertiary care center with the complaint of cough, poor feeding, and breathing difficulties. Based on the investigatory finding, she was diagnosed with PDA with pulmonary arterial hypertension (PAH), an atrial septal defect (ASD), coarctation of the aorta (COA), and pneumonia. In this patient, a left posterolateral thoracotomy was done to accomplish PDA ligation and coarctation repair. The outcomes of the infants were documented using the face, legs, activity, cry, consolability (FLACC) scale, and arterial blood gas analysis. The therapeutic aim specified an increase in oxygen saturation, enhanced total functional capacity, optimized respiration, cleared chest secretions, and normalized cardiovascular function. The effectiveness of the cardiorespiratory physiotherapy treatment regimen based on the patient's existing state of health is the focus of this case report. The outcome variable indicated that the patient's functional recovery was optimal.

What Interventions Do Physical Therapists Provide for Patients With Cardiorespiratory Conditions, Neurological Conditions, and Conditions Requiring Acute Hospital Care? A Systematic Review

OBJECTIVE

The aim of this systematic review was to determine what percentages of physical therapists provide interventions that are of high value, low value, or unknown value for cardiorespiratory conditions, neurological conditions, or conditions requiring acute hospital care. Whether an intervention was considered high or low value was determined by reference to guidelines or systematic reviews.

METHODS

Searches of numerous databases were performed by combining terms synonymous with "practice patterns" and "physical therapy" until April 2018. Studies that investigated what interventions physical therapists provide for any cardiorespiratory condition, neurological condition, or condition requiring acute hospital care through surveys and audits of clinical notes were included. Through the use of medians and interquartile ranges, the percentages of physical therapists who provided interventions that were of high value, low value, or unknown value were summarized.

RESULTS

Twenty-six studies were included. The median percentages of physical therapists who provided interventions of high, low, and unknown value for chronic obstructive pulmonary disease ranged from 78% to 96%, 67% to 100%, and 56% to 91%, respectively. These percentages ranged from 61% to 97%, 87% to 98%, and 83% to 98% for adults who were critically ill in intensive care units; 70% to 93%, 38% to 50%, and 8% to 95% before or after cardiac/thoracic surgery; 25% to 96%, 23% to 84%, and 96% for acute stroke; and 11% (high value) and 13% (unknown value) for Parkinson disease, respectively.

CONCLUSIONS

This review found patterns of physical therapist practice for cardiorespiratory conditions, neurological conditions, and conditions requiring acute hospital care that were both evidence based and not evidence based. A concern is that a substantial percentage of physical therapists provided interventions that were of low or unknown value despite the availability of high-value interventions.

IMPACT

This systematic review is the first, to our knowledge, to summarize the percentage of physical therapist treatment choices that were high versus low value for cardiorespiratory conditions, neurological conditions, and conditions requiring acute hospital care. The findings highlight areas of practice where low-value care could be replaced with high-value care-such as in the management of patients who have chronic obstructive pulmonary disease or who are in intensive care-and identify an urgent need to develop and test strategies to ensure that patients with these conditions receive the interventions most likely to improve their outcomes.

Evaluation of a new chest physiotherapy technique in dogs with airway fluid accumulation hospitalized in an intensive care unit

OBJECTIVE

To evaluate the feasibility, benefits, and adverse effects of prolonged slow expiration (PSE) and assisted cough (AC) as chest physiotherapy (CP) techniques in dogs with airway fluid accumulation.

DESIGN

Prospective interventional study.

SETTINGS

University teaching hospital.

ANIMALS

Intervention group of 30 client-owned dogs and retrospective control group of 71 client-owned dogs.

INTERVENTIONS

PSE was performed on dogs with evidence of airway fluid accumulation, identified based on physical examination and thoracic radiographs. AC was performed if spontaneous cough or swallowing were not evident. The PSE treatment was performed every 6 hours until normalization of respiratory status or hospital discharge. Animals were monitored for respiratory distress, discomfort, and SpO₂ during the procedure. A retrospective control group was identified by computer search.

MEASUREMENTS AND MAIN RESULTS

One hundred thirty-three sessions of CP were performed on 30 dogs. Discomfort frequency during physiotherapy was low (9%). The most commonly used position for CP was in lateral recumbency (95%) and this was well tolerated in most cases. There was no significant difference in the median SpO₂ before and after CP sessions (P = 0.24). Sixty percent of sessions had a spontaneous cough or swallowing evident, 21% had successful AC performed, and no cough or swallowing occurred in the remaining (19%) sessions despite attempts of AC being made. The length of hospitalization was significantly longer in the intervention group (6 days vs 4) (P = 0.02). There was no difference in survival between the intervention (76.7%) and the control (57.7%) group (P = 0.055).

CONCLUSIONS

PSE associated with AC are easily adaptable, well-tolerated techniques in dogs. The benefit of CP in dogs with airway fluid accumulation remains to be determined and it is hoped that future randomized controlled prospective studies may help answer this line of inquiry.