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Intensive care: Patients' experiences

Physiotherapy on the ward

While people are ill in the intensive care unit, they lose weight and can lose about 2% of their muscle mass per day during their illness. This means muscles get weaker, which can result in severe physical disability. Rebuilding these muscles takes time and in some cases can take over a year. If people are immobile (not moving) for some time, their joints may become stiff. To help them recover muscle strength, physiotherapists help them with exercises to restore their mobility.

Most people discussed the physiotherapy they received on the ward and the progress they made daily with the support of physiotherapists. This ranged from moving arms and legs, gripping, walking with a Zimmer frame and crutches, taking their first steps alone, to being able to walk across the ward and, finally, up and down stairs. Many talked about the goal-setting physiotherapists used, which sometimes pushed them to achieve just that little bit more than they felt capable of. At times, some said it felt like 'bullying' and they only really appreciated the physiotherapy with hindsight. One man said the physiotherapists were 'wonderful but cruel' because they made him exercise even when he felt too weak or tired for it.

 

The physiotherapists 'saved his life' because they helped him with breathing difficulties he had.

The physiotherapists 'saved his life' because they helped him with breathing difficulties he had.

Age at interview: 63
Sex: Male
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They're wonderful, cruel ladies and they have to be of course and they have to get you moving because, I realised that, 26 days lying on your back is not good especially when you're ill and it's not good for your muscles and I still feel that now.  Yes, they did come and bully me and they bullied me much more when I went back to the general ward and in fact one of them, I think, probably, it sounds a bit dramatic to say 'saved my life' but when I went back to the general ward I was having great difficulty, which probably had started in Intensive Care, in breathing. And one of the things that the physiotherapist encourages you to do is to breathe. And I found that I could only breathe in to a very brief count of three and then it blocked. What was happening was that I was filling up with fluid, pondweed green fluid. And that was splinting the lungs and stopping me from breathing. 

And the physiotherapist said, "This is not right." This was out of Intensive Care, back on the general ward. She said, "This is not right, you should be able to breathe more than that and also you're really blown up. Like, you know, a sheep in Far from the Madding Crowd [laughs]. And so they did a scan and it was fluid, it was bile I think basically and that was the very worst thing that happened to me [laughs] the whole time, was the tube up the nose and down into the stomach to drain this fluid off.  

I remember the physiotherapist came in one day and said, "Today we do stairs." And it was again one of those times when I was feeling particularly jaded and weary and I said, and she had a young, I think doctor with her, I'm not sure. And I said, "Must we do stairs today?" And she said, "We have boxes to tick." [Laughs] So I did stairs. And she ticked the box. I did the stairs without any difficulties. This was probably after 12 days on the general ward, I expect. 

 

She started off by just being able to stand up and sit down but could eventually walk down the ward.

She started off by just being able to stand up and sit down but could eventually walk down the ward.

Age at interview: 44
Sex: Female
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The physio used to come down, I'd do like, at that time, I'm trying to think now, I know I had the catheter took out, I can't remember now. But they'd get me so that I could stand up and use the commode. I would stand up, they'd put like a box beside the bed and I'd stand up and sit down, do things like that there. Then I'd sit in the chair, just take a couple of steps up to the chair. But they were always, I had hold of them if you know what I mean. I'd do that there. 

Then it got a little bit, they'd follow me behind, somebody would walk with me and they'd follow me behind with the oxygen. And I basically, I did do it bit by bit. I'd walk out to the door. Then I'd go out and walk to the nurses' station. I think on that day before I went up on to the ward, I walked right down to near enough what bed I was in before. And that's how it was. It was just a case of just doing it bit by bit. But I did find it hard. 

Some people stressed how physiotherapists were key in helping them regain strength, mobility and confidence, at this stage in their treatment. Some didn't enjoy physiotherapy at first or particularly like their physiotherapists but, as they grew stronger, looked forward to their exercises. Physiotherapy was 'the highlight' of some people's day. Others wanted to do as much physiotherapy as possible, eager to rebuild their strength and go home.

 

She found it hard to balance properly using a Zimmer frame but continued practising, determined...

She found it hard to balance properly using a Zimmer frame but continued practising, determined...

Age at interview: 55
Sex: Female
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I'd push my feet down and just try and exercise the muscles to get some tone back. I'd lost a lot of weight, which was kind of helpful, so there was less weight in my legs for a change. But then she [physiotherapist] taught me, they came with a frame like the very elderly use for a walking frame, and I was allowed to take about four or five steps. And she came, showed me how to do this. And I also had, I had to be accompanied by somebody the whole time. So I spent, in the morning she came and showed me how to do this, and I just kept doing it and doing it and doing it as often as I could get somebody to stand with me, to go with me.  

But the worst thing was, is losing your balance. And you have this tendency to drop your head down, because your head's lost power and strength, your neck muscles have gone, so your head sort of wobbles around. But the major thing was, is that you have a tendency to look at your feet. And it was making yourself do what they told you to do, which is look straight ahead, to try and keep your head still, and then go for it, to get your balance back. And you just think to yourself, "This is ludicrous. I'm a relatively young woman. I feel like eighty." Maddening. But it was a question of getting out with it and doing it more than anything else. And by that evening she came back, she said, "Oh, God, you've improved so much, just even in a day. I'll try you with two sticks." And she said, "Steecks." Because she's from New Zealand, "I'll try you with two steecks." So I said, "Thank you very much." And it was quite fascinating. She had a nose ring and she had a thing in her tongue as well and dreadlocks, from New Zealand. She was good though, she was great fun. Got me on to a stick. And by the next afternoon I was going flat about eight yards, something like that. Because I was medically fit to leave, but I couldn't leave until I walked. And within I think two and a half days I walked, could walk the length of the corridor and had enough strength and enough balance to actually go up stairs.  

Because I was, also required stairs, because my bedroom here is upstairs. And they said, you know, it was just remarkable. But it's amazing what you can do with determination. You just keep getting up and keep on going and keep practising, and you can do it.

 

She talks about the physiotherapy she had - in ICU, HDU and then on a general ward - until she...

She talks about the physiotherapy she had - in ICU, HDU and then on a general ward - until she...

Age at interview: 40
Sex: Female
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I had different ones [physiotherapists] all the time. They started, they were coming even when I was on Intensive Care. I can remember them bending my knees when I was on Intensive Care. And I wasn't doing anything, I think she was wasting her time. I remember her bending my knees 'cause I remember she had purple rubber gloves on and I was thinking, "That's bizarre." The purple rubber glove, they're bizarre. And then High Dependency I was more able to do things, they had me doing them. And, I didn't enjoy the physiotherapy side of things, they must have thought, oh God. When I see her coming down the ward I just thought, oh God here she comes, but after a while I got strong and I would like look forward to seeing them when they came in. Glad to see them 'cause it meant I could get up and walk and show them I could do stuff.  

Yeah. How long were you on the ward, on the general ward? 

About a week. 

About a week. And then they said you could go home? 

Yeah.

 

He was eager to recover and was sometimes already at the gym doing exercises when the...

He was eager to recover and was sometimes already at the gym doing exercises when the...

Age at interview: 45
Sex: Male
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Even when I went up on to the ward, I mean they said to me, you know, "You'll be three, four weeks." I said, "No, a couple of weeks is all I'm going to be here and I'll be gone." "Well, we'll see." 

But when the physios came, I had a little bit of physio work down in the ICU when I started to come around, and when I went up there [general ward] they obviously got me doing a bit more every day. I suppose after being up there a week I could walk down to the gym on like a Zimmer frame. Sometimes they had to come looking for me, but I was already down there. So they got a bit nervous.  

At first I started off with a Zimmer, first of all the physios sort of walked me down, and then they put me on like a Zimmer frame with little wheels on it. And then it was like, I think it was walking sticks. But they, you know, came with me. Like I said, but by the end of the second week I could walk on the walking sticks. But obviously to get out of the hospital I had to be put in a wheelchair, like health and safety reasons I presume.  

Did they make you try and climb a couple of stairs? 

Oh, yes, oh, yes. When I went down into their little gym sort of thing they were teaching me that. What I was doing in the end, like the second week, I was going down on my own and doing all the bits that they showed me previously. And sometimes they'd come down and say, "Well, we'll try this today." Going upstairs and what have you, and coming back down again. Then I went to a physio in [town], after the hospital. 

Was that through your GP or privately?  

No, that was through the hospital. They advised going to there. So I went there once a week for a couple of hours. But they were quite impressed with how well I'd go on. They said, "Well, there's no really, any need for you to come if you don't want to, you know. If you feel that you're okay and you're happy with it then..." you know. They give me exercises to do at home, which I did all the time. But I was sort of determined to get out and about and walk about. 

Some noted that, like the nurses on the general ward, many of the physiotherapists were also extremely busy and sometimes didn't visit them. Others said that, if they'd been asleep when the physiotherapist had visited, they would miss physiotherapy that day. One of these people fell from his Zimmer frame on one occasion and said he was quickly helped and encouraged to use it again shortly afterwards.

 

He was terrified when he fell into his Zimmer frame but says people must accept the challenges...

He was terrified when he fell into his Zimmer frame but says people must accept the challenges...

Age at interview: 68
Sex: Male
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One occasion getting out of bed with a Zimmer, the next I realised was I was on the floor inside my Zimmer frame. And I was absolutely terrified, absolutely terrified, because there was no way that the two nurses who were in attendance could physically lift me. Only 11' stone or less, and when they said, "Push on your feet" well, there was no co-ordination or strength there. And that was frightening. I perspired. 

The most wonderful thing that ever happened was that within an hour of that experience the physios came and said, "Right, we're going to walk you with a Zimmer frame." And if you can relate to being in a car crash, the recommendation is once you've calmed down, get back in a car and drive again. That had to happen, and fortunately it happened within a time span, which was significant. Within an hour of my having collapsed in a heap on the floor, the physios were there and said, "Right, we're going to walk you with a Zimmer." And they'd no idea that I'd collapsed in a heap. They didn't know until afterwards that that had happened. But that was vitally important.

And, "It's important to recognise" I said to myself and I'm saying to you whoever are listening to and watching what I have to say, "It's important to accept the new challenges that the physios set you or that the hospital staff set you." Challenges where you think, "No, that's too far. I can't do that." Dependent on making use of hospital bottles when you're in bed and moving to the point where you've got to discard them. You think, "I can't do it." And say, "Oh, yes, you can. You've got to do that." Or making use of the commode because you can't, you stop using the bedpan, you move to the commode. And that's a significant move forward. 

Another man was unhappy because he'd waited an extremely long time to have his tracheostomy reviewed. He described how he got strong enough to walk his Zimmer frame to the doctor's office and complain.

 

He just had to talk to a doctor, and managed to use his Zimmer frame alone to walk down the ward...

He just had to talk to a doctor, and managed to use his Zimmer frame alone to walk down the ward...

Age at interview: 66
Sex: Male
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And on one day I said to the physiotherapist when she'd finished the walking exercises and they'd put me in bed, 'cause I was fast in the bed, I had rails, I wasn't allowed to get out without support or help. And I said, "Would you leave the Zimmer frame at the end of the bed please and I want it right at the end of the bed that's where I like it." And she did. And I thought, "Well with my electric bed." "I'm going to do a trick and I'm going to do what I call 'Burial at Sea'." And I got the bed tipped right up so it was raised up and I thought my weight will push me off the end of the bed. And as I get to the end of bed where the Zimmer frame is, I'll hold on to the rails, I'll stand up and I'll be able to walk with my Zimmer frame. 

So I got in my Zimmer frame, I did this off the bed, got in the Zimmer frame and bang, bang, bang and I went all the way up the ward and down the corridor. And I was going to Trust Headquarters, no matter that I'd got pyjamas that didn't fit and my dressing down wasn't fastened, I was going to the Trust Headquarters. And I go so far down the corridor and I met one of the ENT Registrars and they said to me, "Where on earth are you going?" And I said, "Well I'm fed up with this place. I'm going to Trust Headquarters because nobody's helping me with my tracheostomy. I'm supposed to have an appointment to see ENT and I haven't seen them and I jolly well want to know what's going on and I'm not budging." I says, "That's where I'm going." She says, "Well I'm from ENT, I know you, I know your case. Come along and we'll take you in there." And they took me in and I saw the Consultant. He was there, and they sorted it all out for me and I went back to the ward.  

I suppose I was classed as a naughty boy and they then put fasteners on the bottom of the bed as well so I couldn't get out of the sides and I couldn't get out at the bottom.

Many praised the physiotherapists who had helped them, and described them as 'fantastic', encouraging and kind.

 

He greatly valued the physiotherapists and will never forget the support he got.

He greatly valued the physiotherapists and will never forget the support he got.

Age at interview: 33
Sex: Male
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How long were you on this ward for?

I was on it for about a week, the Intensive, sorry the physio that I'd had in Intensive Care was the most excellent, the lady was brilliant and I'll probably never forget what she did for me. She was great but obviously she was upstairs in Intensive Care. I was given or allocated to another physiotherapist, who again, was totally different personality and character but was great because she would be really quite demanding of me. And the things I should be doing or shouldn't be doing, she was fantastic and it's amazing how much progress I made within that week on the second ward. It was great. 

 

The physiotherapists were 'brilliant', sometimes visiting him twice a day, and he continued with...

The physiotherapists were 'brilliant', sometimes visiting him twice a day, and he continued with...

Age at interview: 71
Sex: Male
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And can you remember at what stage the physiotherapist was coming?  

Oh yes they used to come in. Oh they were brilliant. They used to come in every day, a couple of times a day and mainly, not so much for my feet because I didn't have a lot of trouble with my feet. Even though I've lost my toes I haven't lost my balance. But they used to come in to the ward at least once or fairly often, twice a day, to give me physio on my hands because I'd lost, because you know the ligaments were affected. But thanks to them really, you know, my thumb and my forefinger and my little finger are fine. Only two of the, you know the ring finger and the small finger on the right hand are not very good and the specialist said they'll never be 100% but they used to give me all sorts of exercises. We spent a lot of time chatting and talking, you know. And one of the physios there, we used to spend a lot of time talking about rugby and you know, sport. And since coming out of hospital I've been to [town] once a week and down to [city] twice a week for further physiotherapy. And again they are superb. 

National Institute for Health and Care Excellence (NICE) CG83 - 2009 recommends:
 
"While a patient is on the ward, s/he should be given another health check (short clinical assessment) to identify any physical or psychological problems.
 
If the health check shows that the patient could benefit from more structured support, or if this was identified earlier, s/he should then be given a more detailed health check (comprehensive clinical assessment) to identify the patient’s current rehabilitation needs.
 
The healthcare team should talk to each patient about their rehabilitation goals and rehabilitation programme, both of which should take into account the results of their health checks and be tailored to the individual’s needs."

Last reviewed August 2018.

Last updated November 2012.

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