Current rehabilitation practices in intensive care units: a preliminary survey by the Japanese Society of Education for Physicians and Trainees in Intensive Care (JSEPTIC) Clinical Trial Group
© The Author(s). 2016
Received: 4 September 2016
Accepted: 24 October 2016
Published: 28 October 2016
We conducted an internet survey targeting healthcare providers in intensive care units (ICUs) in Japan and received 318 responses. Eighteen percent of respondents replied that full-time physical therapists (PTs) exist in their ICUs. Practicing sitting upright or sitting in a chair is frequently performed, while standing and walking are occasionally performed for patients undergoing mechanical ventilation. However, only 16 % of respondents use staged rehabilitation protocols. This preliminary survey suggests that full-time involvement of PTs in the ICU and introduction of rehabilitation protocols may not be common in Japanese ICUs.
KeywordsRehabilitation Physical therapist Intensive care unit Rehabilitation protocol Early mobilization Questionnaire survey
To the editor
In 2009, Schweickert et al.  first reported that early rehabilitation intervention significantly improved physical and mental function of critically ill patients. Since then, a substantial number of studies have shown the efficacy and safety of early rehabilitation and mobilization in the intensive care unit (ICU) [2, 3]. However, the criteria for determining the timing of initiation and suspension of rehabilitation in ICUs vary among studies, and the existence of standard rehabilitation protocols and the levels of physical therapist (PT) involvement for early mobilization are not yet ubiquitous, even in the USA . It is not surprising that high-quality investigations have not yet been performed to describe the current practice of physical therapy in ICUs in Japan. Therefore, we conducted a preliminary internet survey investigating current practice patterns of physical therapy in Japanese ICUs.
Between January 13 and January 25 in 2016, anonymous questionnaires were distributed to physicians, nurses, PTs, occupational therapists (OTs), and speech therapists (STs), via the website of the Japanese Society of Education for Physicians and Trainees in Intensive Care (JSEPTIC) . In this survey, rehabilitation was defined as any one of the following activities: passive exercise motion, neuromuscular electrical stimulation, respiratory muscle training, use of a cycle ergometer, practicing sitting upright or sitting in a chair, standing, and walking conducted for a patient admitted to an ICU.
Frequency of rehabilitation exercises performed for patients undergoing mechanical ventilation
Frequently, N (%)
Occasionally, N (%)
Never, N (%)
Unknown, N (%)
Joint range of motion exercises
Sitting upright or sitting in a chair
Respiratory muscle training
Neuromuscular electrical stimulation
This preliminary web-based survey suggests that full-time involvement of PTs, OTs, or STs in the ICU and introduction of rehabilitation protocols may not be common in Japanese ICUs. In Europe, 75 % of ICUs had at least one PT working exclusively in the ICU . Most ICUs in Australia also have at least one senior PT on staff . This study suggests that rehabilitation may be provided “on-demand” in most ICUs in Japan. Recently, a consensus on active mobilization, including the criteria for determining when to start or suspend an intervention for patients undergoing mechanical ventilation, has been reported . Risk stratification and safety standards regarding physical therapy and rehabilitation have also been reported . However, this study suggests that in a majority of Japanese ICUs, rehabilitation practice may be performed on an individual-therapist basis, not following established protocols. It has been reported that following physical therapy protocols by an exclusively allocated PT decreased endotracheal intubation and reintubation rates in the ICU and hospital length of stay . A study investigating the effect of protocolized rehabilitation by full-time PTs on patient outcomes is needed. This preliminary survey was made by voluntary participation of an individual respondent who viewed the website of the JSEPTIC Clinical Trial Group. The institutional information of individual respondents was not obtained, making it possible to have multiple respondents from one institution, not reflecting regional disparities in practice. It is acknowledged that selection bias of participants could result from an internet survey. Further studies are needed to clarify these limitations.
Intensive care unit
There are no acknowledgements to be declared.
There is no funding to be declared.
Availability of data and materials
The datasets supporting the conclusions of this article are available in the Japanese Society of Education for Physicians and Trainees in Intensive Care (http://www.jseptic.com/rinsho/questionnaire_490225.pdf).
ST and MS wrote the manuscript. HY, NS, AKL, and the JSEPTIC Clinical Trial Group helped in critically revising the manuscript. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
Consent for publication
Ethics approval and consent to participate
This survey was based on the requirements of the Declaration of Helsinki, and informed consent was obtained from all participants.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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