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Physiotherapeutische Intervention auf der Intensivstation

Outcomerelevante Messparameter

Physiotherapy interventions in the ICU

Outcome-relevant measurement parameters

  • Physiotherapie
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Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Leitlinien können für die Physiotherapie in der Intensivmedizin keine differenzierte Empfehlung bieten. Wissenschaftliche Publikationen zur Physiotherapie auf der Intensivstation weisen zumeist nur ein geringes Evidenzniveau auf und verbleiben oftmals in einer Gewährleistung für eine sichere Durchführbarkeit der Physiotherapie in der Intensivmedizin.

Fragestellung

Welche Messparameter sind outcomerelevant und welche Interventionen sollte man dabei berücksichtigen?

Material und Methode

Eine Literaturrecherche wurde durchgeführt. Zugrunde gelegt wurden eine PubMed-Suche mit Volltextzugang sowie spezifische Begriffsdefinitionen für Physiotherapie, Intensivmedizin und 4 von 7 Rahmenbedingungen aus dem Manual „Physiotherapie in der Intensivmedizin“.

Ergebnisse

Die Verfügbarkeit von 172 Studien stellt klar dar, dass sich die Physiotherapie durchaus mit einem intensivmedizinischen Umfeld auseinandersetzt. Parameter zur quantitativen und qualitativen Erfassung der Vigilanz und des Bewusstseinszustands sowie Assessments zur Beurteilung der Mobilität mittels Medical Research Council (MRC) und Handgrip Dianometry (DM), sowie der Selbsthilfefähigkeit mittels „functional independence measure“ (FIM) und Barthel-Index (BI) weisen jedoch eine aussagekräftigere Verbindung für die tägliche Praxis auf.

Schlussfolgerungen

Die Schwierigkeiten, Physiotherapie auf der Intensivstation sinnvoll einzusetzen, liegen nicht in der Gewährleistung der Sicherheit des Patienten oder der Durchführung einer physiotherapeutischen Anwendung. Die Rahmenbedingungen des intensivmedizinischen Umfelds stellen kein Hindernis dar. Von immanenter Bedeutung ist es, die begrenzte Ressource Physiotherapie optimal und zielgerichtet im Bereich der Intensivmedizin zu nutzen. Die Determination an das Umfeld adaptierter Zielgrößen spielt eine entscheidende Rolle.

Abstract

Background

Guidelines cannot provide differentiated recommendations for physiotherapy (PT) in intensive care medicine. Scientific publications for PT in the intensive care unit (ICU) usually only have low levels of evidence and often express safety and feasibility of PT in the ICU.

Objective

Which measurement parameters are relevant for defining outcome and what interventions should one take into consideration?

Materials and methods

A literature review was conducted. This was based on a PubMed search with full text access, as well as specific definitions for physical therapy, intensive care and four out of seven conditions from the manual “Physiotherapy in intensive care”.

Results

The availability of 172 studies clearly shows that there is certainly PT research concerning the critical environment of the ICU. However, parameters for quantitative and qualitative detection of vigilance and state of consciousness as well as assessments to evaluate the mobility and the ability to help themselves are important for everyday use.

Conclusions

The difficulties of using PT in the ICU are not useful in ensuring the safety of the patient or performing a PT treatment. The conditions of the intensive care environment are not an obstacle. It is of immanent importance to use the limited resources of PT in an optimal and targeted manner in the ICU environment. The determination of ICU-adapted goals plays a crucial role.

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Danksagung

Vielen Dank an Fr. Dr. med. P. Runge für die Betreuung bei der Bachelorthesis.

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    E. Zeiser B.A.

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M.T. Geier, München

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Zeiser, E. Physiotherapeutische Intervention auf der Intensivstation . Med Klin Intensivmed Notfmed 112, 356–370 (2017). https://doi.org/10.1007/s00063-016-0259-4

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