Clinical Standards, Guidelines and Recommendations for Physiotherapy Practice in Intensive Care Units: A Scoping Review

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 Joanna Briggs Institute (JBI) methodology and PRISMA-ScR. Eligible documents addressed physiotherapy and/or respiratory physiotherapy in adult ICUs, including clinical practice guidelines, consensus-based guidelines, practical statements, and local clinical documents. Electronic databases were searched, supplemented by reference-list screening, grey-literature searches, and snowballing. English-language documents published between 2015 and 2025 were included; COVID-19-related publications were restricted to 2022–2025. Records were screened using Rayyan and data were extracted using validated tools.

Results. Twenty-two documents (100%) were included: 17 international and national guidance documents (77%) and five local clinical documents (23%). Regarding ICU settings, nine documents (41%) addressed general ICUs, one (4.5%) burn, and one (4.5%) ECMO. No physiotherapy-specific guidance document for cardiac surgery ICUs was identified. Among the 22 documents, 11 (50%) provided physiotherapy-specific recommendations, while the remaining 11 (50%) addressed physiotherapy within broader ICU guidance documents. Early mobilisation and respiratory physiotherapy were most consistently addressed, whereas guidance on intervention dosage and progression, and specific ICU settings was limited. Local clinical documents generally provided more detailed recommendations than international and national guidance documents.

Conclusions: The evidence base demonstrates substantial gaps in physiotherapy guidance documents, particularly regarding intervention dosage and progression and specific ICU settings, with limited guidance for burn and cardiac surgery ICUs. Findings support adapting international guidance documents to the Ukrainian healthcare context and may inform the development of physiotherapy-specific recommendations for ICU practice.