Masters Degrees (Physiotherapy)

Permanent URI for this collection

https://scholar.sun.ac.za/handle/10019.1/100738

Browse

Browsing Masters Degrees (Physiotherapy) by Author "Conradie, Elmarie"

Now showing 1 - 1 of 1
  • Thumbnail Image
    Item
    The effect of a therapeutic early mobility position on the haemodynamic stability in a critically ill patient population.
    (Stellenbosch : Stellenbosch University, 2016-03) Conradie, Elmarie; Hanekom, Susan D.; Fourie, Cate; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
    ENGLISH ABSTRACT: Introduction Bed rest is routinely prescribed during critical illness which leads to significant inactivity in an adult critically ill population. Survivors will possibly encounter difficulties in their health related quality of life (HRQoL) and physical functioning. The therapeutic use of positioning in the management of an adult critically ill population could minimise the negative effects of bed rest. Method A scoping review was conducted to describe the therapeutic use of positioning in the management adult of critically ill patients. Six electronic data bases were searched by two researchers using specific search strategies. Papers were identified and included using predefined inclusion criteria. Data was extracted into an Excel spreadsheet. Data describing the therapeutic use of positioning was reported in a scoping review and the focussed review explored the effect of the semi-recumbent position on a critically ill patient population. This information was used in planning of the primary study. A non-randomised experimental design was used to evaluate the feasibility of using an adapted early mobility readiness protocol (protocol) to identify patients who could tolerate the therapeutic early mobility position (testing position). We reported on the effect of the testing position on two haemodynamic parameters including the mean arterial pressure (MAP) and the percentage central venous oxygen saturation (ScvO2%). The secondary aim was to describe the current nursing positions used in the surgical and respiratory units (the units) and to describe any adverse events. Twice weekly, all patients nursed in the units were screened with the inclusion/exclusion criteria and the protocol. The patients included were tested in the baseline nursing position followed by the testing position. The MAP and ScvO₂% were measured at 0 minutes, 3 minutes and 10 minutes. Data were described using repeated measures of ANOVA. A 5% significant level (p < 0.05) was used. If data were skewed, medians ranges 95% confidence intervals (CI), mean differences and 95% CI of mean differences were used. Results Nine hundred and thirty-six full text papers were assessed for inclusion into the review. One hundred and thirty-four papers described the therapeutic use of positions. Twelve papers, of which six papers described the effect of the semi-recumbent position and six papers described the clinical outcome of the semi-recumbent position, were included in the focussed review. Uncertainties still surround the haemodynamic stability and the ability of a patient to maintain the 45⁰ semi-recumbent position. A longer period in the 45⁰ semi-recumbent position is needed to evaluate the dynamic interaction of variables like the MAP and ScvO2%. We screened 138 patients using the inclusion/exclusion criteria which 82 patients failed. Eleven (7.9%) patients passed the protocol: male/female (9/2) with a median (range) age of 47 (20-67) years. The placement from the baseline nursing position to the testing position resulted in a mean difference (95% CI) of 2.03 (-1.12 - 5.18) in the MAP and a mean difference (95% CI) of 0.79 (-3.15 - 4.74) in the ScvO2%. Both did not reach statistical significance. Conclusion Guidelines for the use of the 45⁰ semi-recumbent position as a preventative intervention for ventilator associated pneumonia and aspiration do exist but therapeutic use of a position as an early mobility position still needs investigation. The protocol was not able to adequately identify patients who would be able to tolerate the testing position. Further work is needed to refine the criteria of protocol. Our data can inform the process. The outcome of patients nursed in this position needs further investigation.