Date of Award

Fall 2012

Degree Type

Thesis

Degree Name

Master of Science (MSc)

Department

Clinical Epidemiology/Clinical Epidemiology & Biostatistics

Supervisor

Maureen Meade

Co-Supervisor

Deborah Cook

Language

English

Committee Member

Gordon Guyatt, Karen Choong, Margaret Herridge

Abstract

Background & Rationale: Early mobilization (EM) can minimize intensive care unit aquired weakness (ICUAW) among survivors of critical illness. Clinician awareness of ICUAW, perceived barriers to EM, and acute rehabilitation in Canadian ICUs have not been well described.

Objective: To assess (1) awareness of ICUAW and EM, (2) perceived institutional, clinician, patient level barriers to EM, (3) stated practice of acute rehabilitation in Canadian ICUs.

Design: A cross-sectional, self administered postal survey

Setting: Academic Intensive Care Units (ICUs) in Canada

Subjects: 134 physiotherapists and 302 critical care physicians

Interventions & Measurements: Item generation followed a review of relevant literature and discussion with 26 content experts. We reduced the survey to 10 domains and 29 specific questions. The survey intrument was piloted and evaluated for clinical sensibility and intra-rater reliability. Up to 3 surveys were mailed to potential respondents. Descriptive statistics were reported as proportions, means (+/- SD) or mode, as appropriate. We used the chi-squared test to compare proportions and multi-variate logisitc regressions to test for association between independent and dependent variables.

Main Results: The survey instrument had excellent clinical sensibility and good intra-rater reliability (Cohen’s kappa > 0.4). The overall response rate was 71.3% (311/436) including 87.3% (117/134) of physiotherapists and 64.2% (194/302) of physicians. The incidence of ICUAW in the general medical-surgical population was under-recognized by 68.8% of clinicians and 59.8% of clinicians stated they were either insufficiently trained or informed to mobilize mechanically ventilated patients. Excessive sedation and medical instability were perceived as the most important patient barriers. Limited staffing, safety concerns (by nurses) and delayed clinician recognition to initiate EM were key provider barriers to EM. Important institutional barriers to EM included insufficient guidelines and equipment. Only 19.9% of clinicians stated that patients with suspected ICUAW were referred to an out-patient clinic after ICU discharge for long term rehabilitation.

Conclusions: Over 60% of respondents to this national survey underestimated the incidence of ICUAW and do not feel adequately trained to mobilize mechanically ventilated patients. Multiple patient, provider and institutional barriers may also contribute. Clinical leaders and administrators should consider these modifiable factors when designing EM programs in the ICU.

McMaster University Library


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