Provision of physiotherapy services for children in Intensive Care Units in Uganda: A descriptive study

Sendagala, Idah

Provision of physiotherapy services for children in Intensive Care Units in Uganda: A descriptive study

Thesis / Dissertation

2024

Publisher

University of Cape town

Department

Department of Paediatrics and Child Health

Faculty

Faculty of Health Sciences

Abstract

Background: Child morbidity and mortality are still high in Uganda but the provision of critical care services is sub-optimal, characterized by limited accessibility and minimum standardization of services provided in the intensive care units (ICU). The nature and extent of the provision of physiotherapy services for children in ICUs in Uganda is not known, as no published studies have described this before. Aims: This study aimed to describe the provision of physiotherapy services for children in ICUs in Uganda, to lay a foundation for future practice improvements. Methodology: Routinely collected data documented in the medical files and specific data relating to physiotherapy service provision within the preceding 24 hours were extracted for all infants and children admitted to three participating Ugandan ICUs- the national referral hospital, a public tertiary level health facility, and a private hospital, on two study days per week, from January to June 2023. Demographic and clinical admission data were collected as well as specific details regarding referral to physiotherapy, frequency of treatment, and modalities used. One on-site physiotherapist was trained in research methodology and collected data for the specific study site. The data were analyzed using IBM SPSS Statistics version 28.0.1.1 (14). The data were tested for normality using the Shapiro Wilks W test. Continuous data are presented in the results as median (interquartile range), as appropriate for nonparametric data. Categorical data are presented as frequencies and percentages of total. Results: 326 patients were enrolled in this study, 161(49.1%) of which were male. 190 (58.2%) patients received any form of physiotherapy throughout the study period, and 164 (50.3%) patients received treatment in the preceding 24 hours before data collection on the study day. 68.1% of children had a good health status before the ICU admission, and 65.6% of the children were invasively mechanically ventilated on the study day. In 80.5% of patients, physiotherapy referrals were made by the attending doctor. On multivariable analysis, neither the study site nor any specific admission diagnostic category was independently associated with being referred for physiotherapy. Chest physiotherapy (CPT), using passive manual techniques of percussions (89.6%) and vibrations (88.8%), was the most common form of physiotherapy. Passive limb exercises in bed were the most common type of mobilization exercises given (63.4%), more commonly in younger children 6 years of age (p = 0.002). Active out-of-bed mobilization activities were provided in <20% of cases and were more common among older children >6 years of age (p < 0.05). Out of bed mobilization activities were associated with low or no respiratory support requirements (p < 0.001). The majority of children (71.3%) were treated once over the 24 hours preceding the study day. On multivariable analysis, being admitted for the management of an infection (adjusted OR 10.4, 95% CI 1.7 – 63.1; p = 0.01) and increased duration of ICU stay (aOR 1.4; 95% CI 1.2 – 1.5; p < 0.001) were independently associated with increased odds of being treated by a physiotherapist in the 24 hours preceding the study day. Conclusion: Physiotherapy was only provided to approximately half the children admitted to ICUs in Uganda, mostly following a referral from a doctor. Chest physiotherapy using passive manual techniques was the most common technique administered, followed by passive mobilization techniques. Active out-of-bed activities were performed in a minority of cases, more commonly in older children. These findings suggest that physiotherapy practice for children in ICUs in Uganda does not currently meet internationally recommended standards. Practice improvement initiatives are recommended, through research, training, and protocol development, to reach a minimum standard of acceptable physiotherapy care amongst this vulnerable population.

Keywords

Medicine

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