Patients' lived body experiences in the intensive care unit and beyond - a meta-ethnographic synthesis.

INTRODUCTION: Physical therapists supporting patients in intensive care unit (ICU) rehabilitation can improve their clinical practice with insight in patients' lived body experiences. OBJECTIVE: To gain insight in patients' lived body experiences during ICU stay and in recovery from critical illness. METHODS: Through a comprehensive systematic literature search, 45 empirical phenomenological studies were identified. Patients' lived body experiences were extracted from these studies and synthesized following the seven-phase interpretative approach as described by Noblit and Hare. RESULTS: Three lines of argument were illuminated: 1) "recovery from critical illness starts from a situation in which patients experience the lived body as unable;" 2) "patients experience progress in recovery from critical illness when the lived body is empowered;" and 3) "recovery from critical illness results in a lived body changed for life." Eleven third-order constructs were formulated as different kinds of bodies: 1) "an intolerable body;" 2) "an alienated body;" 3) "a powerless body;" 4) "a dependent body;" 5) "a restricted body;" 6) "a muted body;" 7) "a touched body;" 8) "a transforming body;" 9) "a re-discovering body;" 10) "an unhomelike body;" and 11) "a remembering body." CONCLUSION: Patients' lived body experiences during ICU stay and in recovery from critical illness have richly been described in phenomenological studies and were synthesized in this meta-ethnography.

Longing for homelikeness: A hermeneutic phenomenological analysis of patients' lived experiences in recovery from COVID-19-associated intensive care unit acquired weakness.

AIMS: To explore lived experiences of patients recovering from COVID-19-associated intensive care unit acquired weakness and to provide phenomenological descriptions of their recovery. DESIGN: A qualitative study following hermeneutic phenomenology. METHODS: Through purposeful sampling, 13 participants with COVID-19-associated intensive care unit acquired weakness were recruited with diversity in age, sex, duration of hospitalization and severity of muscle weakness. Semi-structured in-depth interviews were conducted from 4 to 8 months after hospital discharge, between July 2020 and January 2021. Interviews were transcribed verbatim and analysed using hermeneutic phenomenological analysis. RESULTS: The analysis yielded five themes: 'waking up in alienation', 'valuing human contact in isolation', 'making progress by being challenged', 'coming home but still recovering' and 'finding a new balance'. The phenomenological descriptions reflect a recovery process that does not follow a linear build-up, but comes with moments of success, setbacks, trying new steps and breakthrough moments of achieving mobilizing milestones. CONCLUSION: Recovery from COVID-19-associated intensive care unit acquired weakness starts from a situation of alienation. Patients long for familiarity, for security and for recognition. Patients want to return to the familiar situation, back to the old, balanced, bodily self. It seems possible for patients to feel homelike again, not only by changing their outer circumstances but also by changing the understanding of themselves and finding a new balance in the altered situation. IMPACT: Muscle weakness impacts many different aspects of ICU recovery in critically ill patients with COVID-19-associated intensive care unit acquired weakness. Their narratives can help nurses and other healthcare professionals, both inside and outside of the intensive care unit, to empathize with patient experiences. When healthcare professionals connect to the lifeworld of patients, they will start to act and communicate differently. These insights could lead to optimized care delivery and meeting patients' needs in this pandemic or a possible next.

A Sense of Being Needed: A Phenomenological Analysis of Hospital-Based Rehabilitation Professionals' Experiences During the COVID-19 Pandemic.

OBJECTIVE: The purpose of this study was to explore lived experiences of rehabilitation professionals working in hospitals during the COVID-19 pandemic, including the ethical issues and moral distress that these professionals might have encountered. METHODS: An interpretative phenomenological study was performed. First-person experiences of rehabilitation professionals (dieticians, occupational therapists, physical therapists, and speech-language therapists) were collected with semi-structured interviews and analyzed with interpretative phenomenological analysis. RESULTS: The data of 39 hospital-based rehabilitation professionals revealed 4 themes: a disease with great impact, personal health and safety, staying human in chaotic times, and solidarity and changing roles. Participant experiences show that the virus and COVID-19 measures had a significant impact on the in-hospital working environment due to the massive downscaling of regular care, due to infection prevention measures, and due to unknown risks to rehabilitation professionals' personal health. At the same time, participants experienced a certain freedom, which made room for authentic motives, connection, and solidarity. Participants felt welcomed and appreciated at the COVID-19 wards and intensive care units and were proud that they were able to fulfill their roles. The findings reflect a wide range of situations that were morally complex and led to moral distress. CONCLUSION: To diminish the long-lasting negative impact of the COVID-19 pandemic and moral distress, employers should empathize with the experiences of hospital-based rehabilitation professionals and create conditions for ethical reflection. Our data show that hospital-based rehabilitation professionals value professional autonomy. Creating room for professional autonomy helps them feel needed, connected, and energized. However, the needs of hospital-based rehabilitation professionals may conflict with organizational rules and structures. IMPACT: Hospital-based rehabilitation professionals were involved in situations they considered morally undesirable, and they inevitably faced moral distress during the COVID-19 crisis. This study offers rationale and guidance to employers regarding how to reduce the long-term negative impact of the COVID-19 pandemic on rehabilitation professionals.

Development of quality indicators for departments of hospital-based physiotherapy: a modified Delphi study.

BACKGROUND: International hospital accreditation instruments, such as Joint Commission International (JCI) and Qmentum, focus mainly on hospital policy and procedures and do not specifically cover a profession such as hospital-based physiotherapy. This justifies the need for a quality system to which hospital-based physiotherapy can better identify, based on a common framework of quality indicators for effective quality management. OBJECTIVE: This study aimed to identify the most important quality indicators of a hospital-based physiotherapy department in the eyes of hospital-based physiotherapists and their managers. METHODS: Based on input from three focus groups and a structured literature review, a first set of quality indicators for hospital physiotherapy was assembled. After checking this set for duplicates and for overlap with JCI and Qmentum, it formed the starting point of a modified Delphi procedure. In two rounds, 17 hospital-based physiotherapy experts rated the quality indicators on relevance through online surveys. In a final consensus meeting, quality indicators were established, classified in quality themes and operationalised by describing for each theme the rationale, specifications, domain and type of indicator. RESULTS: Three focus groups provided 120 potential indicators, which were complemented with 18 potential indicators based on literature. After duplicate and overlap check and the Delphi procedure, these 138 potential indicators were reduced to a set of 56 quality indicators for hospital-based physiotherapy. Finally, these 56 indicators were condensed into 7 composite indicators, each representing a quality theme based on definitions of the European Foundation for Quality Management. CONCLUSION: A set of 56 quality indicators, condensed into 7 composite indicators each representing a quality theme, was developed to assess the quality of a hospital-based physiotherapy department.

Recommendations for Hospital-Based Physical Therapists Managing Patients With COVID-19.

OBJECTIVE: The COVID-19 pandemic is rapidly evolving and has led to increased numbers of hospitalizations worldwide. Hospitalized patients with COVID-19 experience a variety of symptoms, including fever, muscle pain, tiredness, cough, and difficulty breathing. Elderly people and those with underlying health conditions are considered to be more at risk of developing severe symptoms and have a higher risk of physical deconditioning during their hospital stay. Physical therapists have an important role in supporting hospitalized patients with COVID-19 but also need to be aware of challenges when treating these patients. In line with international initiatives, this article aims to provide guidance and detailed recommendations for hospital-based physical therapists managing patients hospitalized with COVID-19 through a national approach in the Netherlands. METHODS: A pragmatic approach was used. A working group conducted a purposive scan of the literature and drafted initial recommendations based on the knowledge of symptoms in patients with COVID-19 and current practice for physical therapist management for patients hospitalized with lung disease and patients admitted to the intensive care unit. An expert group of hospital-based physical therapists in the Netherlands provided feedback on the recommendations, which were finalized when consensus was reached among the members of the working group. RESULTS: The recommendations include safety recommendations, treatment recommendations, discharge recommendations, and staffing recommendations. Treatment recommendations address 2 phases of hospitalization: when patients are critically ill and admitted to the intensive care unit, and when patients are severely ill and admitted to the COVID ward. Physical therapist management for patients hospitalized with COVID-19 comprises elements of respiratory support and active mobilization. Respiratory support includes breathing control, thoracic expansion exercises, airway clearance techniques, and respiratory muscle strength training. Recommendations toward active mobilization include bed mobility activities, active range-of-motion exercises, active (assisted) limb exercises, activities-of-daily-living training, transfer training, cycle ergometer, pre-gait exercises, and ambulation.

"I'm not going to walk, just for the sake of walking ": a qualitative, phenomenological study on physical activity during hospital stay.

Purpose: To understand beliefs, thoughts, attitudes, and experiences related to physical activity during hospital stay in patients and health care providers.Methods: A qualitative, interpretive, phenomenological study examined the common meaning and lived experiences of patients and health care providers related to inpatient physical activity. Data from semi-structured interviews were analysed using qualitative content analysis.Results: A total of 42 participants (18 patients and 24 health care providers) were interviewed. Patients and health care providers described physical activity as a purposeful activity to achieve a goal. In contrast, they talked about physical and mental rest to balance inpatient physical activity. Furthermore, the hospital environment was felt to discourage patients to be physically active with care centred around the hospital beds, frequent disturbances of rest on hospital rooms, and dependency of patients on health care providers as important sources. The ability of patients to perform physical activity was associated with feelings, such as freedom and autonomy.Conclusions: Physical activity during hospital stay is a purposeful activity to achieve a goal, and should be well-balanced with both physical and mental rest according to patients and health care providers. In addition, the hospital environment seems to be a source of low inpatient physical activity. Implications for rehabilitationHealth care providers should offer meaningful activities to engage patients' interest in being physically active during hospital stay.Tailored interventions aiming to increase inpatient physical activity should be balanced with phases of both physical and mental rest.A change of the hospital environment in both culture and the build environment is needed to elicit physical activity in patients during hospital stay.

Patient views regarding the impact of hydrotherapy on critically ill ventilated patients: A qualitative exploration study.

BACKGROUND: Intensive Care Unit Acquired Weakness can be mitigated by early activity and progressive mobilization. Hydrotherapy enables patients to work on their recovery in a very early stage. This may lead to higher levels of self-efficacy, subsequently higher activity-rates and faster functional recovery. Hydrotherapy might positively affect the regaining of control, hope and trust. Our aim is to explore patient perspective regarding the impact of hydrotherapy on critically ill ventilated patients. METHODS: This qualitative exploration study adopted an interpretative phenomenological approach using in-depth, face to face, semi-structured interviews. Questions covered: pre-admission physical activity, perception of hydrotherapy, affection to water, positive and negative experiences and feelings towards the recovery process. Interviews were analyzed using thematic analysis. RESULTS: Twelve patients were enrolled, of which eight could be interviewed. After analyzing, five main themes were found: experiencing consequences of critical illness, feeling safe in the water, being able to move, positive experiences relating to hydrotherapy and experiencing a turning point. CONCLUSIONS: Hydrotherapy seemed to help patients regain control and belief in their recovery. Patients experienced exercising in water as a turning point in their recovery process. This study encourages to continue providing hydrotherapy to critically ill ventilated patients and may stimulate future research.

REPRODUCIBILITY OF THE MODIFIED STAR EXCURSION BALANCE TEST COMPOSITE AND SPECIFIC REACH DIRECTION SCORES.

BACKGROUND: The mSEBT is a screening tool used to evaluate dynamic balance. Most research investigating measurement properties focused on intrarater reliability and was done in small samples. To know whether the mSEBT is useful to discriminate dynamic balance between persons and to evaluate changes in dynamic balance, more research into intra- and interrater reliability and smallest detectable change (synonymous with minimal detectable change) is needed. PURPOSE: To estimate intra- and interrater reliability and smallest detectable change of the mSEBT in adults at risk for ankle sprain. STUDY DESIGN: Cross-sectional, test-retest design. METHODS: Fifty-five healthy young adults participating in sports at risk for ankle sprain participated (mean ± SD age, 24.0 ± 2.9 years). Each participant performed three test sessions within one hour and was rated by two physical therapists (session 1, rater 1; session 2, rater 2; session 3, rater 1). Participants and raters were blinded for previous measurements. Normalized composite and reach direction scores for the right and left leg were collected. Analysis of variance was used to calculate intraclass correlation coefficient values for intra- and interrater reliability. Smallest detectable change values were calculated based on the standard error of measurement. RESULTS: Intra- and interrater reliability for both legs was good to excellent (intraclass correlation coefficient ranging from 0.87 to 0.94). The intrarater smallest detectable change for the composite score of the right leg was 7.2% and for the left 6.2%. The interrater smallest detectable change for the composite score of the right leg was 6.9% and for the left 5.0%. CONCLUSION: The mSEBT is a reliable measurement instrument to discriminate dynamic balance between persons. Most smallest detectable change values of the mSEBT appear to be large. More research is needed to investigate if the mSEBT is usable for evaluative purposes. LEVEL OF EVIDENCE: Level 2.