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Intensive care: Patients' experiences

Physiotherapy in ICU

During a patient’s stay in intensive care, he or she will be seen and treated by a physiotherapist. Physiotherapists try to make sure the patient’s lungs are kept clear by carrying out physiotherapy on their chest. They also exercise the patient’s arms and legs when they are asleep to work the muscles and stop the joints becoming stiff. If a patient was ventilated (connected to a machine to help them breathe) in the ICU, the physiotherapist will give them exercises to help strengthen their lungs and breathing muscles so they can breathe without the machine as they get better. This will reduce the chances of getting a lung infection.
 
As the patient gets better, physiotherapists also help with exercises to get the patient strong enough to get out of bed. When they’re ready, physios will help them get up and moving about again.
 
While a patient is in critical care, he or she should be given a health check (called a short clinical assessment) to identify:
  • any physical or psychological problems
  • the likelihood of any problems developing in the future, and
  • their current rehabilitation needs.

If the health check shows that the patient could benefit from more structured support, he or she should be given a more detailed health check (called a comprehensive clinical assessment) to identify their rehabilitation needs. The healthcare team should talk to each patient about their rehabilitation goals, involving the family and/or carer if the patient is unconscious or unable to give formal consent.*
 
Many people talked about the physiotherapy they had in intensive care.

Some people had vague memories of having physiotherapy while they were sedated. Others discussed the gentle exercises they did daily in order to re-build their strength. The support of physiotherapists helped others to make progress. Some of these people recalled being 'suctioned' or having their lungs cleared to prevent the build-up of secretions.

 

The physiotherapists encouraged her to walk even though she was weak and found it difficult to eat.

The physiotherapists encouraged her to walk even though she was weak and found it difficult to eat.

Age at interview: 44
Sex: Female
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But I did eventually, by pure determination, come off the ventilator. I was still very weak. I was still catheterised. I had physio every day. When they came in they - what's the word - pound on my chest and move the mucus to get it moving. I would slowly sit on the edge of the bed to try and build up my strength. I'd sit in the chair. I found I was so tired all the time. I slowly, I would stand. But all this time I was still on, I had a mask with oxygen. The physio really encouraged me to take a couple of steps, but it was really hard. You know, I looked at myself and it looked like I looked, I can only describe it as, well, I had legs like a sparrow, I'd lost so much weight. I had, when I first came round and had the ventilator in, I could only eat soft foods. But I never had no appetite and I found it, I just didn't feel like eating, I never had no appetite. It really was hard. The food tasted, with having the ventilator in, it tasted awful. There was no taste to it. It was so hard. They did get mad with me because I was not eating. And they said I was using up whatever energy on breathing, and so I wasn't putting on no weight, I wasn't building up no muscle.

The physios in Intensive Care used to come in twice a day. They were fantastic, absolutely, I can't fault them at all. They were very encouraging. I found I could say whatever I wanted. And what was good was that some of them had seen me that day I came in. And they used to come in and manipulate my lungs. And so they knew how ill I was, you know, had been. And so they saw the daily progress. Which did help. 

 

She found the physiotherapists kind and encouraging, and the exercises made her feel she could do...

She found the physiotherapists kind and encouraging, and the exercises made her feel she could do...

Age at interview: 47
Sex: Female
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Do you remember the physios coming in at all? 

I do, once I'd come round a bit I remember the physios. I liked the physios coming round. They were always very, very kind, very apologetic about having to pummel my chest or whatever. But it was never painful. And they were so encouraging. And they gave me exercises to do, which I did religiously because I felt it was something positive I could do to help myself to get better. So if they said, "Do these breathing exercises every hour" that's what I did. And it's been a good experience with the physios, because I continue to go to physio and see the same physio that I saw in hospital.

Being moved or 'hoisted' from the bed to a chair was a sign of improvement for many people. Some, however, found this uncomfortable, painful and embarrassing. Others had found the physiotherapy painful or tiring, and had dreaded their physiotherapists' visits.

 

She was embarrassed when she was hoisted from the bed to a chair and surprised at how weak she...

She was embarrassed when she was hoisted from the bed to a chair and surprised at how weak she...

Age at interview: 23
Sex: Female
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I had physio because of my breathing and then they decided, "Oh, we'll sit you up." You know, "We'll turn you round and sit you up on, you know, at the side of the bed, sort of thing." And I wrote it down because I used to have to write things down, that I wanted to try and stand up. And like I had my nurse at the back of me, and like three physios round me and when I, because, I fell forward sort of thing but they got me and I started crying and I thought, "Why can't I bloody get off this bed?"

And then they had to, I seen a man over the ward from me and I wrote it down that I wanted to sit in a chair like he was. Like a relaxed, comfy chair. So they hoisted me, and that was horrible. And I was like, all my dignity just went because my, I had a gown on and all my backside was hanging out and I thought, "Oh God, just put me back to bed", you know. It's not nice this but by, well, because I were young and, I don't know, and then you've got nurses who are as young as you looking after you and, well I don't know, it's just, it's not right nice.

And you looked at yourself, and how did you feel when you saw yourself?

Oh God, I had to have a, because the first time I saw myself it was when the physios hoisted me on this standing hoist. And because there were a mirror there and they turned me round and pushed me backwards to sit in this chair and I just said to them, "Wait a minute," and I just looked in this mirror and, I don't know, I was shocked. And I thought, because like I didn't have a bath, my hair was a mess, I didn't have no teeth in, I'd lost all this weight. All you could see were like dressings, bags and, oh, I don't know, I was disgusted, you know, it was horrid, it weren't nice.

 

He disliked having physiotherapy but knew he needed it and appreciated the physiotherapists'...

He disliked having physiotherapy but knew he needed it and appreciated the physiotherapists'...

Age at interview: 46
Sex: Male
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But the nurses were great and they were, "Come on." I was like, but I don't want to get out of bed. But they're hoisting me out of bed, I'm nearly dead two week ago you know, and they're hoisting me out of bed and sitting me down. I can't but they're doing it for me own good. I don't want to go out of bed. I just want to relax but if you do that, you're going to go dormant aren't you. They want you moving, they want you getting up and they were brilliant, "You're coming out." "I don't want to." "But you're coming out of bed." 

They're brilliant and the physiotherapist, I used to hate, anybody who's been in intensive care oh the hospital physiotherapy. Oh, horrible. I used to call them horrible people but honestly they're brilliant. I used to go like that, "No". But they do, and they give you all these and they, oh the pain but you have to go through pain and anyway. Ah they were lovely people you know. They love me now. I love them. I've seen them since when I've been back. But you hate them in hospital when they first so, you know what they're doing because you're, "They're putting me through pain. What are they doing this with me leg for, what are they doing this with me arms?"

But if you didn't, you wouldn't move again. They have to do that but you don't like it. Anybody who's been in physio in hospital will tell you they hate them at first. I told them. I told them how I felt about them. And they said, 'We know. We always used to hate coming to you because you were just come, you'd go mad." But they did it for me own good. Even when I was comatised, they were still doing it, I don't know that obviously but they have to keep your body... But that were painful but they had to do it. 

Some people noted how different they now looked, compared to when they were first admitted. Depending on their illness or injuries, some had swollen up, while others had lost a lot of weight. Many praised the ICU staff and treatments they were given to help them survive and regain strength, and the physiotherapy they received on a general ward (see 'Physiotherapy on the ward').

“Several studies have shown that early rehabilitation, beginning at a point when the patient is physiologically stable and continuing through the critical care stay, might improve physical functioning and so contribute to an early discharge from critical care (Bailey et al. 2007).” - National Institute for Health and Care Excellence (NICE) CG83 2009.

* Information from ICU steps.

Last reviewed August 2018.

Last updated May 2015.

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