What if there is No Evidence to Support PT?
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.