Welcome to Health Care POV | sign in | join
Raising the Bar in Rehab

What if there is No Evidence to Support PT?

Published October 7, 2010 10:03 AM by Lisa West

There tend to be a lot of common practices within our profession. We don't have post-op day-one rotator cuff patients lift free weights overhead. We usually don't recommend athletes with femoral stress fractures to keep running, or to continue high-impact activities. Learning these basics is, obviously, the main reason we spend hours in college.

A few "golden rules" have been accepted across the entire PT profession as guidelines to hold therapy in an acute care setting - including, but not limited to: elevating troponin levels, severe hyper/hypotension, newly developed thrombi or emboli, certain cardiac arrhythmias, etc. Of these topics, all have been proven repeatedly in the published evidence literature to confirm the high risk of mobility in these situations.

One common practice, actually, a lack-of-practice is to avoid hip flexion or upright activity with patients who have femoral lines. Most PTs acknowledge the risk of bleeding, pain or clotting off access for medication administration and therefore, avoid activity with these patients. I spent a few hours today trying to find evidence to support this common PT belief and could not find any articles to support it.

In fact, the most recent article I found disproved this theory! Published in 2009 and written by Christiane Perme, PT, of Texas, a retroactive study found that "Physical therapy interventions for selected patients with femoral arterial catheters in ICU with focus on mobility appears to be feasible practice." After reviewing sitting at bedside, standing at bedside, transfers and walking, the authors found no documented adverse effects in terms of bleeding, catheter dislodgement, non-functioning catheters and acute limb ischemia.

How do we take this evidence and start changing the common practice by physical therapists? What if the evidence is limited or if the most recent literature contradicts our practice? How do we mix traditional thinking with progression of research? How do we keep patients safe, yet find innovative ways to treat them?  

 

Reference: Am J. Respir. Crit. Care Med. 2009. Mobilizing patients with femoral arterial catheters during physical therapy interventions did not lead to catheter-related complications.

3 comments

Hey Jason,

Thanks for the comment.

In this specific situation, we can also consider the risks of the actual femoral line itself, even on bedrest.  With insertion of the line, there is a risk of bleeding, and a risk of clot formation.  If the person inserting the line doesn't have a lot of experience or if the patient's anatomy makes for a difficult insertion, there is even more risk of harming adjacent structures.   The risks of mobility with the line seem to be the same risks of having the line alone.  

Lisa

Lisa West October 7, 2010 2:36 PM

Most therapists will err on the side of caution in these situations unless there is absolute evidence that an activity will benefit the patient despite any risk.  The other side of this is what does nsg say?  If nsg says not to move a patient and a therapist says "I have evidence that we should" who do you think wins the discussion?  

Some of our insight into being a therapist should also come from having common sense in regards to patient care and what they should or should not do.  Also at what percentage of risk would we find a benefit for a patient.  If a patient has a 5% risk of bleeding, clotting the line, etc is it worth it? What if the patient becomes a family member, would we take the same risks as a non-family member?

Great blog by the way.

Jason Marketti October 7, 2010 1:56 PM

PingBack from http://topsy.com/community.advanceweb.com/blogs/pt_7/archive/2010/10/07/what-if-there-is-no-evidence-to-support-pt.aspx?utm_source=pingback&utm_campaign=L2

October 7, 2010 11:03 AM

leave a comment



To prevent comment spam, please type the code you see below into the code field before submitting your comment. If you cannot read the numbers in the image, reload the page to generate a new one.

Captcha
Enter the security code below:
 

Search

About this Blog

Keep Me Updated

Recent Posts