Evaluation of a clinical practice guideline for the physiotherapy management of abdominal surgery patients

Ms Kirsty May1, Ms Clare Holdsworth1, Dr Kimberley Haines1, Dr Elizabeth Skinner1

1Western Health, Footscray, Australia

Aim: Physiotherapy following abdominal surgery aims to modify morbidity and prevent pulmonary complications in high risk patients. Despite evidence supporting early mobilisation, clinical practice remains variable. A clinical practice guideline (CPG) may facilitate translation of research evidence into clinical practice. Therefore, the aim of this study was to implement a CPG and evaluate the effectiveness on physiotherapy management of abdominal surgery patients.

Method: Data was collected pre and post guideline implementation through a retrospective audit of medical records. An evidence-based CPG was developed and implemented through education to key stakeholders. Outcomes measured were: referrals of high and low risk patients to physiotherapy, physiotherapy intervention and rates of early mobility.

Results: Referrals to physiotherapy increased post implementation by 3% for high risk and 12% for low risk patients. There was an improvement in correct physiotherapy management of low risk patients, where 40% of patients did not receive physiotherapy intervention post implementation. For high risk patients receiving physiotherapy, there was a 6% increase in mobilisation as the primary intervention. There was an increase in early mobilisation rates post implementation with 63% of patients ambulating on the first postoperative day compared to 52% pre-CPG implementation.

Significance of the findings to Allied Health: The results of this study demonstrate that translation of research evidence into clinical practice is possible through the implementation of a CPG. The ongoing variability in clinical management, suggests that a CPG is only one aspect of clinical decision making, but can support clinicians to justify their decisions with greater confidence.