Clinical standards, guidelines and recommendations for physiotherapy practice in intensive care units: a scoping review

Abstract

Abstract Introduction Since 2022, the increasing number of injuries in Ukraine has created an urgent need to strengthen rehabilitation services, particularly physiotherapy in intensive care units (ICUs). Materials and methods This scoping review followed the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Eligible English-language documents published between 2015 and 2025 addressed physiotherapy and/or respiratory physiotherapy in adult ICUs, including general, cardiac surgery, and burn ICUs, and comprised clinical practice guidelines, consensus-based guidelines, practical statements, local clinical documents; COVID-19-related publications were restricted to 2022–2025. Electronic databases were supplemented by reference-list screening, grey-literature searches, and snowballing. Records identified through database searches were imported into Rayyan. Grey literature was assessed independently outside Rayyan using the same eligibility criteria. Results 21 documents (100%) were included: 16 international and national guidance documents (76.2%) and 5 local clinical documents (23.8%). 9 documents (42.9%) addressed general ICUs, 1 (4.8%) burn ICU, and 1 (4.8%) extracorporeal membrane oxygenation. No physiotherapy-specific guidance document for cardiac surgery ICUs was identified. 11 documents (52.4%) provided physiotherapy-specific recommendations, while 10 (47.6%) addressed physiotherapy within broader ICU guidance documents. Early mobilisation and respiratory physiotherapy were most consistently addressed, whereas guidance on intervention dosage, progression, and specific ICU settings was limited. Local clinical documents generally provided more detailed recommendations. Conclusions The evidence base demonstrates gaps in physiotherapy guidance documents, particularly regarding intervention dosage, progression, and specific ICU settings. Findings support adapting international guidance to the Ukrainian healthcare context and developing physiotherapy-specific recommendations for ICU practice.