Physiotherapy provision and practice: A EuropeAn Intensive CarE Unit (ICU) survey (PEAiCE) – A profile of ICU physiotherapy in Europe

BACKGROUND: Physiotherapy is an essential component of respiratory management and mobilisation/rehabilitation for patients in the Intensive Care Unit (ICU). However, the current practices across Europe related to organisational models, referral pathways, or clinical techniques are not well-defined. PURPOSE: To examine physiotherapy provision and practice of respiratory management and mobilisation/rehabilitation for mechanically ventilated patients in European ICUs. METHODS: An online survey was developed, piloted and distributed in 11 languages via national coordinators, professional societies, and social media. The ICU physiotherapy leads, or in their absence, medical/nursing leaders from each ICU (one reply per ICU), completed the survey, which included information regarding ICU structure, physiotherapy provision, and current practice. Data were analysed descriptively. RESULTS: In total, 845 responses from 33 countries were included, with the largest representation from Spain (12%), the United Kingdom (11%), and France (11%). Most respondents were physiotherapists (88%) working in university hospitals (69%) and caring primarily for adult ICU patients (87%). Less than half (41%) of physiotherapists were dedicated to ICU, but 91% of them had received some ICU-specific training. Physiotherapy is initiated upon a referral in 52% of ICUs. It usually includes routine respiratory assessment (80%) and both respiratory management and mobilisation/rehabilitation for mechanically ventilated patients (85%). The most common techniques included endotracheal suctioning (55%) and manually assisted cough (51%), with less frequent use of mechanical insufflation-exsufflation (20%) and saline instillation (18%). Mobilisation/rehabilitation was widely practised, with 76% of respondents reporting patients sitting at the edge of the bed, 69% standing, and 71% walking during their ICU stay. CONCLUSIONS: Physiotherapy is a well-integrated part in European ICUs with physiotherapists providing both respiratory management and mobilisation/rehabilitation techniques, although heterogeneity persists in organisation, referral pathways and the use of specific techniques. IMPLICATIONS FOR CLINICAL PRACTICE: These results inform the development of future training and workforce planning, ultimately improving interprofessional ICU care across Europe, particularly in underrepresented areas.