Clinical Algorithm Overview

Pulmonary Function


Delphi Study Results

Contact Details


This website was developed as a place to reach international consensus amongst clinicians; academics/researchers; and members of the interdisciplinary team involved in ICU patient management (nurses; intensivists) on a best practice physiotherapy clinical algorithm.

NOTE: The author had access to the clinical guidelines developed by the European respiratory Society of Intensive Care Medicine task force which was recently published (Gosselink et al 2008). These recommendations were incorporated into the algorithm where applicable.


The way forward

  • These results will be collated into management algorithms using the following key words based on the consensus median rating

    • DO Rating 1
    • SHOULD DO Rating 2
    • CONSIDER Rating 3
    • UNIMPORTANT Rating 4
    • DETRIMENTAL Rating 5

  • The evidence based protocol will be implemented over 4 three week periods in a surgical ICU starting 1 November 2008. Patient outcomes from protocol care will be compared to usual care.

  • The abdominal surgery; rehabilitation and pulmonary dysfunction groups are currently working on publications for submission this year.

Site content:

The electronic Delphi research process


The participants of this electronic Delphi study was identified through:

  • Publication profile on the subject areas as identified during the review process.
  • Membership of the Critical Care Society of South Africa

This sample includes

  • Physiotherapists; intensive care nurse practitioners; intensivists; surgeons; psychologists and respiratory therapists from various countries including
  • Australia; Belgium; Brazil; Canada; Italy; South Africa; Sweden; Switzerland; Turkey; UK and USA.
  • Participants have been divided into five groups. This division was made by the author based on the publication profile as well as a random allocation to specific subject areas


A three stage Delphi process will be undertaken for each of the clinical algorithms.

Stage 1: Each group will review one of the six clinical algorithms, as well as the best practice recommendations formulated. The members of the mobilization group will review both the active and passive mobilization algorithms.

  • You will be guided through each step of the algorithm as well as the best practice recommendations and asked whether you agree or to propose an alternative procedure.
  • Eventhough the entire site is visible to all panel members you will only be allowed to post a comment on the subject that you were allocated to
  • You will be requested to provide your unique log in and password when you attempt to post a comment
  • The database will save your comments and you have unlimited access to these postings while the stage is active. You will be able to change the comments during this time
  • Once the time has elapsed the comments will be used by the researcher for data analysis and postings during phase two
  • These comments will be anonymous and only be visible to the author.

Stage 2: The items where consensus had been reached will now be excluded.

  • At this stage consensus will be defined as the point where 75% of the members agree on an item (Keeny et al 2005).
  • For the remaining items the alternative procedure or physiotherapy interventions proposed by members will be listed.
  • You will now be asked to rank your preference on a scale of 1-5 (Refer to table 2).

Table 2: Anchor points for stage two of Delphi study

Rating Scale

Stage 3: The same list of items described in stage two will again be published.

  • However, two extra pieces of information for each element will now be added.
  • The first piece of information being your ranking and the second piece of information the level of agreement within the group of experts as a whole indicated by shading each score within one point of the median rating for each item (for example, if the median rating for a particular item was 2, then the ratings 1, 2 and 3 will be shaded).
  • You will then be asked to reconsider your original ratings from stage 2 in the light of this new information.
  • If your new rating is outside the shaded area (indicating that you disagree with the rest of the panel), you will be asked to comment on your reasons for making the rating.
  • This information will be incorporated into the final clinical algorithm.
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