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Title: What factors affect implementation of early rehabilitation into intensive care unit practice? A qualitative study with clinicians
Austin Authors: Parry, Selina M;Remedios, Louisa;Denehy, Linda;Knight, Laura D;Beach, Lisa;Rollinson, Thomas C ;Berney, Susan C ;Puthucheary, Zudin A;Morris, Peter;Granger, Catherine L 
Affiliation: Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
Department of Physiotherapy, Austin Hospital, Heidelberg, Victoria, Australia
Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
Department of Physiotherapy, Royal Melbourne Hospital, Parkville, Victoria, Australia
Critical Care, University College Hospital, London, United Kingdom
Department of Critical Care, University of Kentucky, Lexington, KY
Issue Date: Apr-2017
Date: 2016-11-12
Publication information: Journal of Critical Care 2017; 38: 137-143
Abstract: PURPOSE: To identify the barriers and enablers that influence clinicians' implementation of early rehabilitation in critical care. MATERIALS AND METHODS: Qualitative study involving 26 multidisciplinary participants who were recruited using purposive sampling. Four focus groups were conducted using semistructured questions to explore attitudes, beliefs, and experiences. Data were transcribed verbatim and thematic analysis was performed. RESULTS: Six themes emerged, as follows: (1) the clinicians' expectations and knowledge (including rationale for rehabilitation, perceived benefits, and experience), (2) the evidence for and application of rehabilitation (including beliefs regarding when to intervene), (3) patient factors (including prognosis, sedation, delirium, cooperation, motivation, goals, and family), (4) safety considerations (including physiological stability and presence of devices or lines), (5) environmental influences (staffing, resources, equipment, time, and competing priorities), and (6) culture and teamwork. Key strategies identified to facilitate rehabilitation included addressing educational needs for all multidisciplinary team members, supporting junior nursing staff, and potential expansion of physiotherapy staffing hours to closer align with the 24-hour patient care model. CONCLUSIONS: Key barriers to implementation of early rehabilitation in critical care are diverse and include both clinician- and health care system-related factors. Research targeted at bridging this evidence-practice gap is required to improve provision of rehabilitation.
DOI: 10.1016/j.jcrc.2016.11.005
Journal: Journal of Critical Care
PubMed URL:
Type: Journal Article
Subjects: Barriers
Recovery of function
Intensive care
Appears in Collections:Journal articles

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