Table 2. Assessment items determined as essentials (consensus >70% ‘essential’).
| Round 1 | Round 2 | Round 3 | |
| As a minimum standard a physiotherapist can accurately interpret readings from clinical monitoring including: | |||
| Body temperature | 100 | ||
| Heart rate | 100 | ||
| Blood pressure | 100 | ||
| Basic ECGs, SpO2/pulse oximetry | 100 | ||
| End tidal carbon dioxide | 96.2 | ||
| Fluid intake and output | 100 | ||
| As a minimum standard a physiotherapist can understand equipment (including recognition of equipment) and understand the implications for physiotherapy of: | |||
| Oxygen therapy devices | 100 | ||
| Endotracheal tubes and tracheostomy | 92.3 | ||
| Central venous catheters | 88.5 | ||
| Arterial lines | 96.2 | ||
| Venous blood gas interpretation (including SvO2) Vascath/haemodialysis catheter/continuous veno-venous. |
61.5† | 88 | |
| Intercostal catheters | 84.6 | ||
| Wound drains | 80.8 | ||
| Indwelling urinary catheter | 100 | ||
| Nasogastric tubes | 100 | ||
| As a minimum standard a physiotherapist can accurately interpret findings from laboratory investigations including: | |||
| Haemoglobin | 100 | ||
| Platelets, APTT, INR | 92.3 | ||
| White cell count | 88.5 | ||
| Blood glucose levels | 100 | ||
| As a minimum standard a physiotherapist is aware of the actions and implications for physiotherapy of the following medications: | |||
| Vasopressors/inotropes | 84.6 | ||
| Basic electrolytes | 100 | ||
| Anti-hypertensives | 92.3 | ||
| Anti-arrhythmia | 100 | ||
| Sedation and neuromuscular paralysing agents | 61.5* | 92 | |
| Bronchodilators | 92.3 | ||
| Mucolytics | 69.3* | 92 | |
| As a minimum standard a physiotherapist can independently interpret findings from imaging investigations (excluding the imaging report) including: | |||
| Chest radiographs | 96.2 | ||
| As a minimum standard a physiotherapist can interpret the results from neurological equipment/examinations and functional tests including: | |||
| Intra-cranial and cerebral perfusion pressure monitors | 96.2 | ||
| An ability to interpret an assessment of sedation levels (e.g. Ramsey Sedation Scale, Riker, Richmond-Agitation Sedation Scale) | 84.6 | ||
| An ability to perform a neurological examination of motor and sensory functions (e.g. light touch, pain) e.g. ASIA score | 100 | ||
| An ability to interpret a Glasgow Coma Score | 100 | ||
| As a minimum standard a physiotherapist can perform and accurately interpret the results of common respiratory examinations including: | |||
| Observation of respiratory rate | 100 | ||
| Patterns of breathing | 96.2 | ||
| Palpate the chest wall | 100 | ||
| Auscultation | 100 | ||
| As a minimum standard a physiotherapist understands the key principles of providing the following differing modes of mechanical/assisted ventilation including: | |||
| CPAP | 92.3 | ||
| PEEP/EPAP | 96.2 | ||
| SIMV (volume)/(pressure) | 69.2* | 92 | |
| BiLevel | 46.2* | 88 | |
| PS/IPAP | 92.3 | ||
| As a minimum standard a physiotherapist can assess and interpret mechanical ventilation settings/measurements including: | |||
| Respiratory rate | 96 | ||
| Peak inspiratory pressure | 92.3 | ||
| Inspiration: expiration ratio | 100 | ||
| Tidal volume | 100 | ||
| Breath types (spontaneous, mandatory, assisted) | 100 | ||
| The levels of FiO2 | 100 | ||
| The levels of PEEP | 100 | ||
| The levels of PS | 88.5 | ||
| As a minimum standard a physiotherapist can: | |||
| Assess the effectiveness/quality of a patient’s cough | 100 | ||
| Record and interpret observations from physical clinical examination | |||
| As a minimum standard a physiotherapist can interpret indices from blood-gas measurement including: | |||
| pH | 100 | ||
| PaCO2 | 100 | ||
| PaO2, SpO2, SaO2 | 100 | ||
| HCO3 | 100 | ||
| Base excess | 92.3 | ||
| P50 | 65.4† | 92 | |
| A physiotherapist can complete musculoskeletal and/or functional assessments including: | |||
| Manual muscle testing | 69.2* | 84 | |
| Range of motion | 84.6 | ||
| Deep-vein thrombosis screening | 100 | ||
| Peripheral oedema | 92.3 | ||
| As a minimum standard a physiotherapist can understand equipment (including recognition of equipment) and understands the implications for physiotherapy of: | |||
| Extra-corporeal membrane oxygenation | 69.2* | 80 | |
| Intracranial pressure monitors and extra-ventricular drains | 96.2 | ||
| As a minimum standard a physiotherapist can accurately interpret readings from clinical monitoring including: | |||
| Advanced ECGs | 80.8 | ||
| Nutritional status including feed administration, volume and type | 61.5* | 100 | |
| As a minimum standard a physiotherapist can accurately interpret findings from laboratory investigations including: | |||
| Haematocrit | 96.2 | ||
| Creatinine kinase | 96.2 | ||
| Neutrophil count | 92.3 | ||
| Albumin | 92.3 | ||
| Liver function tests | 88.5 | ||
| As a minimum standard a physiotherapist is aware of the actions and implications for physiotherapy of the following medications: | |||
| Calcium channel blockers, cerebral diuretics, hypertonic saline | 96.2 | ||
| Nitric oxide | 92.3 | ||
| As a minimum standard a physiotherapist can independently interpret findings from imaging investigations (excluding the imaging report) including: | |||
| Skeletal X-rays | 96.2 | ||
| CT – Brain | 100 | ||
| CT – Chest | 100 | ||
| CT – Spine | 100 | ||
| MRI – Brain | 100 | ||
| MRI – Spine | 96.2 | ||
| MRI – Chest | 100 | ||
| Ultrasound – Chest | 96.2 | ||
| As a minimum standard a physiotherapist can interpret the results from neurological equipment/examinations and functional tests including: | |||
| Electroencephalograms | 88.5 | ||
| An ability to perform a Glasgow Coma Score | 100 | ||
| An ability to perform an assessment of sedation levels | 100 | ||
| An ability to interpret an assessment of cranial nerve function | 96.2 | ||
| As a minimum standard a physiotherapist understands the key principles of providing the following differing modes of mechanical/assisted ventilation including: | |||
| High frequency oscillatory ventilation | 88.5 | ||
| As a minimum standard, a physiotherapist can assess and interpret mechanical ventilation settings/measurements including: | |||
| Static and/or dynamic lung compliance measurements | 92.4 | ||
| Upper and lower inflection points of P-V curves | 92.4 | ||
| Maximum inspiratory pressure measurements | 92.4 | ||
| Maximum expiratory pressure measurements | 88.5 | ||
| As a minimum standard a physiotherapist can: | |||
| Assess the effectiveness/quality of a patient’s cough Record and interpret observations from physical clinical examination | 100 | ||
| Perform respiratory function tests (e.g. for measurements of FEV1, FVC, PEF) | 100 | ||
| Perform and interpret percussion note | 96.2 | ||
| Measure peak cough flow on or off mechanical ventilation | 84.6 | ||
| Measure peak inspiratory flow rate: Peak Expiratory Flow | 80.8 | ||
| Perform a spontaneous breathing trial | 96 | ||
| Interpret the rapid shallow breathing index | 80.8 | ||
| Perform a swallow assessment | 84.6 | ||
| As a minimum standard a physiotherapist can interpret indices from blood gas measurement including: | |||
| PaO2/FiO2 ratio | 100 | ||
| A-a gradient | 61.6* | 96 | |
| Oxygen content (CaO2) | 88.5 | ||
| Venous blood gas interpretation (including SvO2) | 69.2* | 88 | |
| A physiotherapist can complete musculoskeletal and/or functional assessments including: | |||
| Dynamometry | 88.5 | ||
| Objective measures of physical function | 100 | ||
| Perform and Interpret Chelsea Critical Care Physical Assessment Tool | 92.3 | ||
| Objective measures of cardiopulmonary exercise tolerance | 100 | ||
| Objective measures of quality of life | 84.6 | ||
| As a minimum standard a physiotherapist can provide the following techniques, including an understanding of indication, contraindications, evidence for technique and progressions: | |||
| Positive pressure devices for airway clearance (e.g. AstraPEP, PariPEP, TheraPEP, or oscillating expiratory pressure devices like Acapella, Flutter) | 96.2 | ||
| Periodic/intermittent CPAP (non-invasive via mask) including initiation and titration of NIV/BiPAP – for Type I or Type II respiratory failure, initiation and titration of e.g. COPD exacerbation with hypercapnia | 92.3 | ||
| NIV/BiPAP – intermittent, short term applications during physiotherapy to assist secretion mobilisation techniques or lung recruitment including initiation and titration of assisted coughing - subcostal thrusts for spinal cord injuries | 57.7* | 84 | |
| Ventilator hyperinflation via an endotracheal tube or tracheostomy | 46.2* | 92 | |
| As a minimum standard a physiotherapist can appropriately request/coordinate the following | |||
| Titration of inotropes to achieve physiotherapy goals | 82.6 | ||
| As a minimum standard a physiotherapist is aware: | |||
| Of key literature that guides evidence-based physiotherapy practice in critical care settings | 96.2 | ||
| As a minimum standard a physiotherapist can accurately interpret readings from clinical monitoring including: | |||
| Central venous pressure | 100 | ||
| As a minimum standard a physiotherapist can accurately interpret findings from laboratory investigations including: | |||
| Renal function tests e.g. urea and creatinine | 100 | ||
| Sputum cultures | 96.2 | ||
| As a minimum standard a physiotherapist can | |||
| Determine the appropriateness of a patient for extubation | 82.6 | ||
| Determine the appropriateness of a patient for tracheostomy decannulation | 82.6 |
ECG = electrocardiogram; SpO2 = oxygen saturation; SvO2 = mixed venous oxygen saturation
APTT = activated partial thromboplastin time; INR = international normalised ratio; CPAP = continuous positive airway pressure
PEEP/EPAP = positive end-expiratory pressure; SIMV = synchronised intermittent mandatory ventilation; PS = pressure support
IPAP = inspiratory positive airway pressure; FiO2 = fraction of inspired oxygen; PaCO2 = partial pressure of CO2
PaO2 = partial pressure of O2; HCO3 = bicarbonate; P50 = oxygen tension at which haemoglobin is 50% saturated
CT = computed tomography; MRI = magnetic resonance imaging; FEV1 = forced expiratory volume in one second
FVC = forced vital capacity; PEF = peak expiratory flow
*Consensus not reached (>70%) after considering the scored of ‘unsure’
†Consensus not reached (>70%)