Intra-hospital physical therapy for patients with critical lower limb ischaemia: an expert consensus

ABSTRACT Critical limb ischemia (CLI) is a disease with a great burden for the healthcare system, patient’s functionality and quality of life. However, there is little evidence to guide intrahospital physical therapy programs for patients with CLI. Thus, this study aimed to provide an expert consensus on intrahospital physiotherapeutic care for CLI patients. An expert panel was made up with 18 experienced physical therapists, which represented 85.7% of physical therapists from a reference vascular surgery team in a university hospital. The Delphi method was used to produce a consensus, considering a minimum agreement of 70% and a mean or median score in the Likert scale ≥3.1. The questionnaires included items related to assessment, goals and physiotherapeutic interventions prior and after revascularization. A consensus was reached on assessing symptoms, cognitive, articular, musculoskeletal and cardiorespiratory functions. Pain control, edema drainage, range of motion gain, walking incentive and health education are goals in the pre-operatory and the muscular strengthening in postoperatory phase. In both phases there was a consensus on the use of passive, active-assisted and active exercises, including upper limb exercises. Walking and therapeutic education are essential during the hospitalization period with offloading practices in area of plantar ulcer. Electroanalgesia should be used in preoperative phase and resisted exercises and lower limb elevation at postoperatory.

摘要：重症下肢缺血（Critical limb ischemia, CLI）是一种给医疗系统、患者肢体功能与生活质量带来沉重负担的疾病，但目前尚缺乏可用于指导该类患者院内物理治疗方案的相关证据。为此，本研究旨在针对重症下肢缺血患者的院内物理治疗护理形成专家共识。本研究组建的专家委员会由18名经验丰富的物理治疗师组成，覆盖某大学医院参考血管外科团队中85.7%的物理治疗师。研究采用德尔菲法达成共识，设定最低同意阈值为70%，且李克特量表得分的均值或中位数需≥3.1。问卷内容涵盖血管重建术前、术后的评估指标、治疗目标与物理治疗干预方案相关条目。最终共识明确需对患者的症状、认知、关节、肌肉骨骼及心肺功能进行评估；术前治疗目标包括疼痛控制、水肿引流、活动范围改善、行走激励与健康宣教，术后治疗目标则为肌肉力量强化。在术前与术后两个阶段，均达成共识的物理治疗方案包括被动运动、辅助主动运动与主动运动，其中涵盖上肢训练。住院期间需开展行走训练与治疗宣教，并针对足底溃疡区域实施减压措施。术前阶段可使用电镇痛治疗，术后阶段则需开展抗阻运动与下肢抬高训练。