Current Rehabilitation Practices of Physiotherapists in Intensive Care Units in the UAE: A National Survey

Study objectives

This study aims to explore the current physiotherapy practices in ICUs across the UAE.

Study design and participants

This cross-sectional study was conducted in the UAE and included physiotherapists registered with the Emirates Physiotherapist Society (EPS) from all emirates. Eligible participants were physiotherapists working in private or public UAE hospitals, holding at least a bachelor’s degree, and having a minimum of one year of experience. Physiotherapists that worked in adults or neonatal ICUs were invited to answer the survey. However, physiotherapists who do not specialize in ICU rehabilitation were excluded from the study.

Ethical approval was obtained from the Research Ethics Committee of the University of Sharjah. A list of hospitals that offer physiotherapy services was collected from the EPS, and the emails of the registered physiotherapists were retrieved from the EPS website. A cover letter explaining the study’s purpose, along with the questionnaire, was then emailed to the physiotherapists. Participants received a hyperlink to the informed consent form, and those who consented to participate were granted access to the questionnaire. Data collection started on the 19^th of September 2022 and completed on the 2^nd of December 2023.

Sample size calculation

We recruited 80 physiotherapists from hospitals across the UAE. The target number was determined a priori using Epi Info (Centers for Disease Control and Prevention 2022), set for 80% statistical power and α = 0.05. We assumed a prevalence of routine ICU rehabilitation practice of approximately 90%, based on the proportions reported in comparable surveys from Greece (Grammatopoulou et al. 2017), Australia (Wiles & Stiller 2010), and Türkiye (Çakmak et al. 2019). Entering this expected proportion, a 5% absolute precision, and a two-sided confidence level of 95% yielded a minimum required sample size of 73; we oversampled to 80 to accommodate potential non-response or incomplete questionnaires.

Survey development

The study aimed to review the current practices of physiotherapists in ICUs in the UAE. A literature review was conducted to identify gaps in knowledge and inform survey questions. Questions were developed based on the literature review, covering participant demographics, types of interventions used, session frequency and duration, and challenges faced by physiotherapists in delivering care. The survey was created with a mix of open-ended and close-ended Likert questions for easy administration and analysis. The questions were kept simple and short to be familiar to the participants. The survey was first drafted in English before being transferred to an online platform using Google Forms. No translation of the questionnaire was provided to participants. The data collected was then downloaded into Excel for further analysis.

The survey was pre-tested with a small group of physiotherapists to make sure it was clear, relevant, and easy to understand. The feedback from the testing was used to improve the survey, ensuring that the questions were clear and accurately captured the information needed from participants. This process helped fine-tune the survey before it was given to a larger group of physiotherapists working in ICUs in the UAE.

Questionnaire validity and reliability

To examine the questionnaire’s validity, a group of three experts specialized in physiotherapy practice was invited to judge the content, construct, clarity, and relevance. After the formulation of the first draft that included 30 items gathered from the previous literature, the experts added 36 items. Afterward, the experts assessed the relevance and clarity of the questions and the significance and completeness of responses. Each item in the questionnaire was assessed by the experts on Likert scale that ranges from 1 to 10 where a score that ranges from 1 to 4 means irrelevant or unclear, a score that ranges from 5 to 7 means partially relevant or partially clear, and a score that ranges from 8 to 10 means highly relevant or clear. Then, they started an open online discussion with several coworkers from different emirates in the UAE to assure the understandability, completeness, plausibility, and management of the instrument.

For reliability analysis, a different group of ICU physical therapists in UAE were invited online to test the reliability of the questionnaire. Thirty physical therapists completed the process of pilot testing followed by the calculation of Cronbach’s alpha which is a way of assessing reliability by comparing the amount of shared variance, or covariance, among the items making up an instrument to the amount of overall variance. Finally, Cronbach’s alpha value of 0.843 was inducted which infers a good reliability.

Statistical analysis

Data was extracted from Google Forms and then IBM SPSS Statistical software (version 27) was used to conduct all the descriptive statistics and analysis. Descriptive data analysis included calculating the frequencies and percentages of the participants’ demographic data. Chi square test was used to study the association between the different domains of the questionnaire and the demographic data.

Ethical statement

This research project was approved by the Ethics Committee of the University of Sharjah, UAE [Certificate# REC-21-07-04-01-S]. Also, written informed consents were obtained from all participants before proceeding with the study questionnaires. All study procedures were conducted according to the ethical considerations stated by the declaration of Helsinki (Goodyear et al. 2007). At the beginning of the questionnaire, participants were asked to read a short paragraph about the components of the questionnaire and the main objectives. After that, if they agree to participate, they must click the “agree to participate” button before proceeding to fill in the questionnaire. However, they have the option of quitting the questionnaire at any time while they are proceeding through the various aspects of the questionnaire.

Demographic characteristics

As shown in Table 1, out of 103 invited physiotherapists, 80 participated in the study (Response rate 77.6%), comprising 47.5% females and 52.5% males. The age range of participants varied, with nearly two-thirds of participants (61.3%) in the age group of 25 to 34 years. Regarding the distribution across emirates, 40% of the participants were working in Dubai, 27.5% in Abu Dhabi, 25% in Sharjah, and the rest were from other emirates. In terms of the type of hospital, 47.4% of participants worked in private hospitals, 48.8% in public hospitals, and only 3.8% in university hospitals.

Participants’ years of experience as a physiotherapist ranged from 1 to over 20 years, with about 55% of the sample having physiotherapy experience between 2 and five years. Specifically, the years of experience working in ICU settings were noticeable, with 50% of participants having between 5 and 10 years of ICU experience. Regarding the last earned academic degree in physiotherapy, 52.5% of participants held a bachelor’s degree, 31.2% had a master’s degree, 12.5% held a doctoral degree, and only 3.8 had a diploma in physiotherapy.

Among the participants, the vast majority (96.3%) reported that a physician’s referral was necessary to initiate physiotherapy sessions in the ICU, while only 3.8% indicated no requirement for a referral. Additionally, 75% of physiotherapists reported the presence of a development program at their hospital aimed at enhancing the skills of physiotherapists working in ICUs.

Regarding the establishment of protocols for physical therapy assistance, 75% of participants reported that the protocols were defined by a scientific team within their service, while 25% reported otherwise. Furthermore, 82.5% of physiotherapy services had certification or quality seals indicating adherence to standardized practices.

Physiotherapy respiratory practices

Table 2 presents the survey results of physiotherapy practices. These results provide insights into the different practices among physiotherapists. Regarding the assessment of vital parameters such as heart rate, respiratory rate, and SPO₂ pre- and post-treatment, a majority of respondents (84.1%) reported assessing these parameters always. However, a notable portion (7.2%) reported only sometimes or seldom conducting these assessments.

In terms of involvement in ventilator management, 55.1% of participants reported frequent participation in setting ventilator parameters, indicating a significant role in critical care settings. However, a considerable proportion (13%) reported never involvement in ventilator management. Similarly, while the prescription and teaching of deep breathing exercises were noted to be frequent by 73.9% of respondents, a small portion (4.3%) indicated some involvement.

Respiratory therapy techniques such as vibration, suctioning, and percussion were reported to be performed with varying frequencies. For instance, 72.5% of participants reported frequent use of vibration, while 63.8% reported frequent suctioning. Additionally, the utilization of postural drainage positions varied, with approximately 66.7% of respondents performing postural drainage positions frequently.

The use of AMBU during chest physiotherapy and suctioning was reported to be frequent by more than half (53.6%) of participants. Similarly, nearly half (44.9%) of the respondents reported frequent involvement in the weaning of patients from mechanical ventilation.

Regarding nebulizer application, approximately 36.2% of respondents reported frequent use before treatment, while 49.3% reported frequent use post-treatment.

Lastly, the survey revealed that a majority of physiotherapists frequently make discharge recommendations for the progression of rehabilitation at home (71%) and involve/advice parents or caregivers in the treatment plan and/or discharge plan (73.9%).

Physiotherapy modalities and techniques

As presented in Table 3, the survey results provide comprehensive insights into the utilization of various physiotherapy modalities and techniques in the ICU setting. Among the surveyed physiotherapists, the application of passive/active range of motion exercises emerged as a common practice, with the majority (92.5%) reporting always applying these exercises. Additionally, bed mobility exercises and assistance in bed transfers were frequently implemented by 83.6% and 79.1% of respondents, respectively.

Neuromuscular electrical stimulation, a modality used to facilitate muscle contraction and improve muscle strength, was reported to be frequently applied by 56.7% of participants. Similarly, stretching exercises were commonly performed by 58.2% of respondents. However, continuous passive motion (CPM) machines, which aid in joint mobilization and rehabilitation, were less common, with about one-quarter of respondents reporting seldom or never using it in the ICU setting.

Massage techniques and scar tissue mobilization were reported to be moderately applied by respondents, with 35.8% and 32.8%, respectively. Taping, another therapeutic modality used to provide support and stability to muscles and joints, was reported to be frequently applied only by 19.4% of participants.

At discharge, 44.8% of respondents routinely applied a walk test, while the majority of physiotherapists (73.1%) reported routinely making discharge recommendations for the progression of rehabilitation at home.

Involving and advising parents/caregivers in the treatment and discharge plan was considered essential by the majority of respondents (73.1%).

Utilization of physiotherapy techniques on neonates

The last part of the survey included questions about the utilization of physiotherapy techniques, specifically in Neonate Intensive Care Unit (NICU) (see Table 4). The results provide valuable insights into the utilization of various physiotherapy modalities and approaches for neonates in the NICU setting. Passive range of motion exercises emerged as a commonly performed intervention, with the majority of respondents (85.7%) indicating that they always perform these exercises for neonates in the NICU.

Positioning to support alignment and movement was reported to be frequently applied, with 71.4% of respondents.

A significant proportion of respondents reported therapeutic handling for neonates with movement impairments, with 66.7% indicating that they frequently perform therapeutic handling interventions. Likewise, orofacial stimulation in neonates was reported to be always considered by 50% of respondents. However, nearly one-quarter (23.8%) reported seldom use of this approach with the neonates.

Hydrotherapy, a modality involving therapeutic activities in water, was never considered by 23.8% of respondents, with only 9.5% indicating that they always consider hydrotherapy for neonates.

Massage techniques and scar tissue mobilization were reported to be occasionally applied by respondents, with 21.4% and 23.8%, respectively.

The utilization of taping for neonates was infrequent, with only 7.1% of respondents indicating that they sometimes apply taping techniques.

Teaching parents skin-to-skin holding, also known as kangaroo mother care, emerged as a relatively commonly practiced intervention, with 38.1% of respondents indicating that they always teach parents skin-to-skin holding for neonates. Furthermore, the involvement and advice of parents in the treatment plan for neonates were considered essential by the majority of respondents (69%).

The demographic findings

This study offers the first detailed snapshot of physiotherapists working in UAE ICUs, illuminating gender balance, age structure, geographic distribution, experience levels, referral pathways, and quality-assurance credentials.

Participants were almost evenly split by sex, with a slight male majority—contrasting the female dominance generally reported in critical-care physiotherapy (Ou et al. 2022). The reasons for this reversal merit investigation, as gender mix may influence teamwork and patient rapport. Most respondents (55%) were 25–34 years old, mirroring data from Singapore (Ou et al. 2022) and Brazil (Matilde et al. 2018) and signalling a generational shift toward younger practitioners on the ICU floor. Understanding why early-career clinicians gravitate to, or remain in, critical care could inform retention strategies and tailored professional-development programmes.

A large share of respondents worked in Dubai, predominantly within private and public (government) hospitals. This urban concentration reflects the emirate’s dense healthcare infrastructure and underscores the need for planning mechanisms that address potential rehabilitation-service gaps in less-served regions.

Although Saudi ICUs report that half of physiotherapists possess more than ten years of experience (Alqahtani et al. 2020), the present study found that 55% of UAE clinicians have only 2–5 years in practice, confirming a youthful workforce. While fresh graduates bring contemporary training, limited tenure may affect clinical depth; continuous education initiatives are therefore critical for building advanced competencies in complex cardiorespiratory management (Viloria et al. 2023).

Nearly all respondents indicated that a physician’s order is mandatory before commencing physiotherapy—a pattern consistent with Saudi, Brazilian, and Nepalese ICUs (Baidya et al. 2016; Matilde et al. 2018; Alqahtani et al. 2020). In contrast, Canadian physiotherapists practise autonomously in most settings (Bath et al. 2018). While mandatory referrals may strengthen interdisciplinary oversight, they can also delay mobilisation; examining referral efficiency and potential shortcuts for routine interventions may enhance patient outcomes. A high prevalence of institutional certification or quality seals was reported, signalling commitment to evidence-based protocols and systematic audit. Such accreditation can bolster patient confidence and align practice with international benchmarks.

Collectively, these demographics paint a picture of a young, increasingly gender-balanced ICU physiotherapy workforce clustered in Dubai’s mixed public-private sector and operating under physician-led referral systems. Further research should explore how age, gender, and experience interact with patient outcomes and interdisciplinary dynamics, thereby guiding workforce planning and optimising critical-care rehabilitation in the UAE.

Physiotherapy practices in the ICU

In terms of physiotherapists’ practices, the results offer valuable insights into the diverse practices among participants, highlighting both areas of consistency and potential variations in clinical protocols.

Most respondents (84.1%) “always” measured heart rate, respiratory rate, and SpO₂ before and after therapy—reflecting recommendations that vital signs guide safe intervention (Sapra et al. 2024). Yet 7.2 % reported doing so only “sometimes/seldom,” indicating inconsistent adherence to guidelines. Over half of the physiotherapists (55.1%) frequently adjusted ventilator parameters, confirming their recognised role in optimising mechanical ventilation; by contrast, 13% reported no involvement, echoing earlier reports of uneven engagement in respiratory management (Lee et al. 2017; van der Lee et al. 2021). These disparities underscore the need for standardised protocols and stronger interprofessional collaboration.

Passive and active range-of-motion exercises were the most common treatment, with 92.5% of clinicians employing them routinely. This proportion far exceeds the 15.4% reported in earlier studies (Reid et al. 2018) and suggests a regional preference for manual mobility techniques aimed at preventing contracture and preserving joint function (Rahiminezhad et al. 2022). Bed mobility drills and assisted transfers were similarly prevalent, underlining a focus on early functional rehabilitation.

Neuromuscular electrical stimulation and stretching were used by more than half of respondents, respectively. Electrical stimulation can curb muscle wasting and improve function in the critically ill (García-Pérez-de-Sevilla & Sánchez-Pinto 2023), though its limited efficacy in adults over 75 years (Nonoyama et al. 2022) may explain the moderate uptake observed. Continuous passive-motion devices were used by roughly one-quarter of physiotherapists, signalling either resource constraints or uncertainty about benefit.

Hydrotherapy was seldom considered, reflecting concerns about safety, staffing, and the practical challenges of transferring ventilated patients to aquatic environments (Felten-Barentsz et al. 2015; Wegner et al. 2017). These barriers warrant further study before widespread adoption can be recommended.

Fewer than half of clinicians (44.8%) routinely employed walk tests at discharge, yet 73.1% formulated home-based rehabilitation plans and involved parents or caregivers in education and decision-making. This emphasis on continuity of care aligns with evidence that family engagement improves adherence and functional recovery after critical illness.

The overall pattern points to a holistic yet heterogeneous approach to ICU physiotherapy in the UAE. While routine monitoring and mobility interventions are well-embedded, significant variability exists in advanced respiratory management and modality choice. Standardising evidence-based protocols—particularly for ventilator optimisation, NMES parameters, and discharge assessment—could reduce practice gaps. Simultaneously, integrating caregivers into rehabilitation planning should remain a priority to facilitate seamless transitions from hospital to home. Further research should examine barriers to guideline uptake, evaluate outcomes of seldom-used modalities such as hydrotherapy, and verify the effectiveness of existing mobility programmes in diverse ICU populations.

Clinical applications and future research directions

The findings from this survey of ICU physiotherapy practice in the UAE delineate priorities and gaps that can immediately inform bedside care while guiding future inquiry. Adult ICU physiotherapists reported near-universal use of passive and active range-of-motion routines, bed mobility drills, and assisted transfers—interventions that curb muscle atrophy, contracture, pressure injury, and deconditioning, thereby accelerating recovery (Hashem et al. 2016). Advanced measures such as neuromuscular electrical stimulation and ventilatory-optimising positioning were also common, mirroring an expanding respiratory-rehabilitation remit with evidence for shortening ventilation time and improving ICU survival (Nonoyama et al. 2022). Embedding these evidence-based algorithms within multidisciplinary ICU protocols would standardise and strengthen care.

In neonatal ICUs, respondents endorsed passive limb movements, therapeutic handling, and orofacial stimulation—techniques that nurture neuromotor maturation and feeding skills (Chokshi et al. 2013). Parental participation through kangaroo mother care was likewise emphasised, echoing reports that early skin-to-skin contact enhances bonding and empowers families (Chan et al. 2016). Nonetheless, substantial variation in intervention choice, timing, and dosage persists across both adult and neonatal settings.

Future work should therefore pursue randomised or pragmatic trials to establish optimal onset, frequency, and duration of core modalities; define NMES parameters and positioning protocols that maximise weaning success and pulmonary outcomes; and rigorously evaluate emerging neonatal tools such as hydrotherapy and taping alongside family-centred education models to refine developmental care and parental satisfaction (Jahan et al. 2021). By addressing these priorities, healthcare providers can transform heterogeneous practice into consistently high-value rehabilitation for critically ill adults and neonates in the UAE and comparable settings.

Study limitations

While the study provides valuable insights into applying physiotherapy techniques in critical care and neonatal settings, some limitations should be acknowledged. First, the reliance on a convenience sample of physiotherapists introduces potential sampling bias. This sampling method may not adequately represent all practitioners in critical care and neonatal settings, potentially skewing the findings toward individuals with specific interests or expertise in physiotherapy. Consequently, the results may not generalize to the broader population of physiotherapists working in diverse healthcare contexts. Second, the data collected were based on self-reported responses from physiotherapists, which may be susceptible to self-reporting bias. Participants may have provided responses influenced by recall or social desirability bias, leading to overestimating, or underestimating certain practices. Moreover, self-reported data may not accurately reflect actual clinical practices, as respondents may have provided responses, they deemed more socially acceptable or aligned with best practices. Lastly, the study’s cross-sectional design only provides a snapshot of practices at a single point in time. While cross-sectional studies offer valuable insights into current practices, they do not allow for examining temporal trends or establishing causal relationships. Longitudinal studies would be necessary to assess changes in physiotherapy practices over time and their potential impact on patient outcomes.