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.

	Delphi Study Results
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:

• Why is it necessary to have an internationally validated best practice physiotherapy clinical algorithm?
• Process of development
• Structure of the site
• The electronic Delphi research process
• How will this internationally validated best practice physiotherapy clinical algorithm (BPPCA) be evaluated?
• Which outcomes will be measured?
• References

How will this internationally validated best practice physiotherapy clinical algorithm (BPPCA) be evaluated?

A RCT methodology will be used to answer the question. Funding was obtained for a physiotherapy post in the surgical ICU at a tertiary hospital in Cape Town South Africa. Three therapists will be appointed for the duration of the study to provide a physiotherapy service which includes an on call service. Patients will be randomly assigned to receive usual care or protocol care.

Usual care was evaluated in this unit in 2004 (Hanekom et al 2006) based on the baseline data collected over a five month period of the physiotherapy service provided and techniques used by the therapists in the management of patients in this surgical unit. The elements of this usual care included:

• Treatment provided 7 days a week during working hours.
• The majority of patients were treated once daily before 11 am in a semi recumbent position with a regime including manual techniques (percussions and vibrations or a vibromat) and suctioning.
• Mobilization (active or passive) of the patient was only utilized in a very small proportion of patients.

A pilot study will be completed in the unit before the implementation of the best practice algorithm to determine current usual care.