Purpose: This project presents a case of an individual who was difficult to mobilize in a sub-acute trauma unit and answers the following PICO question via evidence-based analysis: Does equipment-assisted or manually-assisted transfer training result in better and more quickly improved functional independence levels for patients who are difficult to mobilize in acute care? Background: Acute care physical therapists typically resort to manual handling techniques for functional mobility tasks involving transferring patients. In this way, PTs encourage as much independence as possible, making every day transfers like supine-to-sit and sit-to-stand therapeutic. There are, however, patient populations who would benefit from a more gradual, equipment-mediated approach to verticality and lower extremity (LE) weight-bearing, among them the critically ill, bariatric patients, and patients with high levels of movement fear and anxiety. While most equipment-based research has focused on reducing injury for the health care provider, there is emerging research regarding the therapeutic and functional patient outcomes available when equipment techniques rather than manual techniques are utilized. Case Description: Mr. W., a 79-year-old man underwent elective bilateral total hip replacements but he developed several complications including sepsis revision surgery, an unstageable sacral pressure ulcer, and extreme fear and anxiety when he attempted any movement. After spending 4 days in initial post-surgical acute care rehabilitation, the patient was discharged to a skilled nursing facility for 2 weeks before being readmitted for revision surgery and subsequently referred to physical therapy (PT). Outcomes: A review of the current available evidence revealed that patient handling equipment includes a broad and heterogeneous collection of items. The circumstances for its use are varied and involve a high level of clinical decision making on the part of the physical therapist. Equipment-based approaches range from hoyer type ceiling-based lifts to manual sit-to-stand aids used for varying reasons and in varying patient populations. A select few studies demonstrated the intriguing and applicable use of an adjustable tilt table as a graded squat machine for critically ill patients. This equipment and its utilization represented the best evidence-based option for easing the case study patients transition from supine to lower extremity weight bearing. Discussion: This case presentation describes a patient in acute care with a rare diagnosis who was difficult to mobilize. The aim of the investigation was to determine what might have been utilized to improve his physical therapy care. The available research comparing manual to equipment-based interventions for functional mobility is limited and of relatively low quality. This is partially due to the difficulty involved in assembling a large and homogenous enough group of patients, all of whom interact with the same piece of equipment. Evidence is also limited due to the fact that equipment-based interventions are normally undertaken with the aim of preventing provider injury rather than enhancing patient outcomes. There are a few studies that indicate that the application of equipment-based patient handling involving graded mobilization and lower extremity weight-bearing may have facilitated the case study patient's rehabilitation while helping to decrease his anxiety and fear of movement. Instead of using equipment to affect the desired transitional movement itself, equipment could have been used to train this significantly immobile patient so that he could better participate in more traditional manual sit-to-stand training.
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Patient handling, equipment, rehabilitation, acute care physical therapy, functional mobility
Dickinson, Maria. "Manual- versus Equipment-Based Functional Mobility Training in Acute Care - An Evidence Based Analysis." (2015). http://digitalrepository.unm.edu/dpt/112