Hello everyone. When I assumed the Section presidency, I assumed the responsibility of writing a column for each issue of the Journal. No one provided me with direction in terms of content; our editor simply gave me deadlines for the column. I have tried several different approaches to content and none have been critiqued, so I am left floundering about with regards to what it is exactly that I should write. In this edition of President's Perspective, I would like to continue my struggle with content and bring to your attention the power of words.
In his editorial for the June 2016 volume of Physical Therapy, Alan Jette took strong exception to the use of terms such as “physiotherapy and occupational therapy” and “physical therapy practices” in the literature as descriptors of these rehabilitation interventions delivered to patients. Such terms are generic, and imprecise labels are often used to describe specific treatment interventions with the apparent expectation that a reader would know exactly what is being described.1 Given the wide variety of interventions physical therapists might use in managing a specific pathology or injury and the variability within each specific intervention, the imprecision of such terms makes it virtually impossible to understand the “what and how's” of the used interventions, thus making the translation of findings from the literature into clinical practice often difficult, if not impossible.
As you might have guessed, I too have a “bone to pick” with a frequently used clinical term that is imprecise and lacking in clarity—early mobilization. Immobility has long been a standard of care for high-acuity patients, particularly those in the intensive care unit (ICU), because of safety concerns, complexity of care, patient equipment, and the belief that energy conservation is important in promoting recovery.2 We have learned over the last couple decades or so that once these patients leave the acute care setting, they face a future of amplified symptom burden and an increased likelihood of multiple functional impairments.3 Efforts to ameliorate this situation have led to the delivery of a higher “dose” of physical therapy earlier in the clinical course of a critical illness. A number of such “early mobilization” programs have been described in the literature, and most report that such programs bring about greater gains in functional ability, fewer days spent on ventilators, and less time spent in the ICU than patients who received limited or no physical therapy care at all.4–6
Despite the positive outcomes that can result from providing physical therapy services to high-acuity patients, the term “early mobility” persists as the descriptor for this particular intervention. Early is defined in the Merriam-Webster dictionary as (1) near the beginning of a period of time and (2) before the usual or expected time. Relative to the first definition, not all “early mobilization” programs are initiated near the beginning of an ICU admission; rather, they are initiated when patients are best able to safely tolerate such interventions. Relative to the second definition, the available data would suggest that the usual time at which physical therapy interventions are initiated with critical care patients is either late or unnecessarily delayed, resulting in negative consequences for the patient. In either case, the use of the word “early” is imprecise and runs the risk of incorrectly characterizing the time point that it is trying to define. Rather than being early, available data would suggest that the initiation of these mobilization programs is probably “appropriately” timed rather than being “early.” What timing adjective would I suggest be used to describe this particular intervention? I do not know, perhaps “appropriately timed mobilization.” Of course, that term is cumbersome, too long, and besides “ATM” is too well ensconced as a banking term and thus has no chance of being used as a medical acronym.
To be fair, aggressive mobilization of patients in the ICU is not universally successful.7 Perhaps, the day will come when the presence of a physical therapist in the ICU constitutes the standard staffing model for this unique clinical environment8 rather than being an exception to the staffing model! Having physical therapists routinely treating patients in the ICU and serving as involved members of the medical team could help ensure that rehabilitation services are initiated at the most appropriate time and are most appropriate for that patient, thus helping ensure optimal outcomes.
OK, lets leave wordsmithing behind, think about specialization. I am happy to report that the Section's efforts to advance the specialization process are on track and moving forward. The Specialty Council, which is overseeing this process, continues to seek item writers and will be holding item writing workshops in 2018.
Combined Sections Meeting (CSM) will be held in New Orleans in February 22-24, 2018. The business meeting for the Section will be held on Friday, February 23, 2018, from 6:30 to 8:00 PM. The Celebration of Life will be held immediately after the business meeting. Please plan on attending the business meeting as the Board of Directors of the Section is suggesting that the Section's name be changed to the Academy of Oncologic Physical Therapy of the American Physical Therapy Association, Inc., and that decision will be made in the business meeting.
Please seek me out at CSM, and let's talk about the Section.
G. Stephen Morris, PT, PhD, FACSM
1. Jette AM. Language matters. Phys Ther. 2016;96:754–755.
2. Morris P. Moving our critically ill patients: mobility barriers and benefits. Crit Care Clin. 2007;23:1–20.
3. Herridge MS, Tansey CM, Matte A, et al Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364:1293–1304.
4. Weeks A, Campbell C, Rajendram P, Shi W, Voigt LP. A descriptive report of early mobilization for critically ill ventilated patients with cancer. Rehabil Oncol. 2017;35:144–150.
5. Engel HJ, Tatebe S, Alonzo PB, Mustille RL, Rivera MJ. Physical therapist-established intensive care unit early mobilization program: quality improvement project for critical care at the University of California San Francisco Medical Center. Phys Ther. 2013;93:975–985.
6. Aquaroni Ricci N, Aparecida Bordignon Suster É, de Moraes Paisani D, Dias Chiavegato L. Effects of early mobilisation in patients after cardiac surgery: a systematic review. Physiotherapy. 2017;103(1):1–12.
7. Callahan LA, Supinski GS. Early mobilization in the intensive care unit: help or hype? Crit Care Med. 2016;44:1239–1240.
8. Malone D, Ridgeway K, Nordon-Craft N, Moss P, Schenkman M, Moss M. Physical therapist practice in the intensive care unit: results of a national survey. Phys Ther. 2015;95(10):1335–1344.