Role of Physiotherapy in Patient Management
Physiotherapists serve as essential members of multidisciplinary healthcare teams, delivering evidence-based interventions across three core domains: exercise prescription and physical activity promotion, respiratory management in critically ill patients, and comprehensive rehabilitation for cardiovascular and chronic diseases. 1
Core Clinical Domains
Exercise and Physical Activity Prescription
Physiotherapists are specifically trained to conduct exercise tests, promote physical activity, and prescribe exercise programs for patients with complex comorbid conditions and physical impairments across the disability spectrum 1. Exercise represents one of the most important and effective interventions that physiotherapists incorporate into patient care plans to promote health and wellness 1.
The evidence demonstrates that therapeutic exercise is beneficial across broad areas of practice, including multiple sclerosis, osteoarthritis of the knee, chronic low back pain, coronary heart disease, chronic heart failure, and chronic obstructive pulmonary disease 2. The effectiveness increases when exercise is relatively intense, targeted, and individualized rather than standardized 2.
Cardiac Rehabilitation
Physiotherapists are central to delivering comprehensive cardiac rehabilitation, which includes exercise training, physical activity promotion, health education, cardiovascular risk management, and psychological support 3. This multicomponent intervention is recommended for patients with acute coronary syndrome, heart failure with reduced ejection fraction, and following coronary revascularization 3.
Cardiac rehabilitation programs led by physiotherapists improve coronary heart disease risk factors, health-related quality of life, mental wellbeing, and exercise capacity 3. The programs typically consist of group exercise sessions starting from the seventh postoperative day, risk-factor management education, and home-based exercise manuals including upper-limb, lower-limb, breathing, and aerobic exercises 3.
Critical Care and Respiratory Management
Physiotherapy assessment in critically ill patients focuses on physiological and functional deficits rather than medical diagnosis alone, leading to targeted intervention prescription 3. Assessment must determine the underlying problem amenable to physiotherapy and which specific interventions are appropriate, with continuous monitoring of vital functions to ensure treatments are both therapeutic and safe 3.
Early Mobilization in ICU
Early mobilization after initial cardiorespiratory and neurological stabilization reduces time to wean from mechanical ventilation and forms the basis for functional recovery 3. Prolonged bed rest in the ICU leads to deconditioning, muscle weakness, dyspnea, depression, anxiety, and reduced quality of life 3.
The mobilization approach follows a structured progression 3:
- Positioning to increase gravitational stress and fluid shifts, with upright positions increasing lung volumes and gas exchange 3
- Passive range of motion or electrical muscle stimulation for hemodynamically unstable patients 3
- Active-assisted exercises as tolerance improves
- Standing and walking aids (modified walking frames, tilt tables) when appropriate 3
- Aerobic training and muscle strengthening in addition to routine mobilization for ventilated patients with chronic critical illness 3
Patients with hemodynamic instability or those requiring high FiO2 and high levels of ventilatory support are not candidates for aggressive mobilization 3. The risk of moving a critically ill patient must be weighed against the risks of immobility and recumbency 3.
Respiratory Interventions
Cardiorespiratory physiotherapy optimizes secretion clearance, gas exchange, lung recruitment, and aids with weaning from mechanical ventilation 4. Physiotherapists manage retained airway secretions, atelectasis, pneumonia, acute lung injury, postoperative pulmonary complications, chest trauma, and weaning failure 3.
Multimorbidity Management
Approximately 50% of patients referred for cardiac rehabilitation have two or more comorbidities, and multimorbidity is a strong risk factor for both non-use and non-completion of rehabilitation programs 3. Patients with multimorbidity require personalized rehabilitation models that address their complex needs rather than single-disease management approaches 3.
Collaborative Practice Requirements
Physicians must implement standardized information checklists when referring patients to physiotherapists and develop formal communication processes during key transition points: initial referral, treatment phase, and guidance phase 1. Physicians should work collaboratively with physiotherapists to select physical activity assessment methods that fit the clinical setting and allow meaningful longitudinal follow-up 1.
Evidence-Based Outcomes
A 6-week upper and lower limb training program improved limb muscle strength, increased ventilator-free time, and improved functional outcomes in patients requiring long-term mechanical ventilation 3. Home-based cardiac rehabilitation programs like REACH-HF demonstrate clinical effectiveness and cost-effectiveness, with improvements in health-related quality of life and acceptable cost per quality-adjusted life year 3.
Common Pitfalls to Avoid
- Delaying mobilization until after ICU discharge rather than initiating early after stabilization 3
- Viewing critically ill patients as "too sick" for physical activity when they may benefit from appropriately dosed interventions 3
- Failing to address multimorbidity in rehabilitation programs designed for single-disease management 3
- Inadequate monitoring during interventions, risking patient safety 3
- Standardized rather than individualized exercise prescription, which reduces effectiveness 2