Provision of physiotherapy services for children in intensive care units in Uganda: A descriptive study.

Abstract

Background: No prior studies have described physiotherapy practices for critically ill and injured children admitted to intensive care units (ICUs) in Uganda, a low-income African country with high childhood morbidity and mortality.

Objectives: To describe the patient profile and physiotherapy practices of children admitted to Ugandan ICUs.

Methods: Routinely collected data were extracted for all infants and children admitted to three participating Ugandan ICUs on two study days per week over six months. Demographic and clinical admission data were collected, as well as data on physiotherapy service provision, including referral practices, frequency of treatment and modalities used.

Results: A total of 326 patients (49.4% male) were enrolled in the study, on median (interquartile range (IQR)) ICU Day 4.0 (2.0 - 8.0). Most children (63.5%) were >2 years of age. Physiotherapy had been provided to 190 (58.2%) children during their ICU admission. Physiotherapy referrals were made by the attending doctor in 80.5% of cases. Chest physiotherapy - percussions (89.6%) and vibrations (88.8%) - was the most common technique, followed by passive limb exercises in bed (63.4%). Active out-of-bed mobilisation activities were provided in <20% of cases, mostly among children <6 years of age (p<0.05) and those with minimal or no respiratory support requirements (p<0.001). No invasively mechanically ventilated children were actively mobilised out of bed.

Conclusion: Over 40% of children admitted to Ugandan ICUs did not receive any physiotherapy contact during their admission, suggesting missed opportunities. Most physiotherapy techniques were passive; active out-of-bed activities were seldom implemented and were reserved for older, non-ventilated patients.

Contribution of the study: This is the first study to describe physiotherapy practices for children admitted to intensive care units in Uganda, providing an important baseline for targeted, context-appropriate practice improvement initiatives. The study demonstrates that physiotherapy services in Ugandan ICUs are predominantly passive, referral-dependent and inconsistently applied. Active rehabilitation, including out-of-bed mobilisation, is seldom implemented, representing missed opportunities for early rehabilitation in a resource-constrained setting with a high paediatric critical illness burden.