Special edition of "Australian Critical Care" - A collaborative allied health research culture in intensive care

This month a special issue of Australian Critical Care journal, published in Clinical Key for Nursing, focusses on research by allied health professionals (AHPs) and the benefits of multidisciplinary, collaborative research in intensive care. Professions under the banner of allied health include physiotherapy, speech pathology, occupational therapy, dietetics, psychology, and pharmacy and represent around 20% of health professionals in Australia. However, there is a lack of high-quality evidence to guide clinical care in most allied health professions, leading to an expansion in allied health research.

Evidence-based practice in intensive care aims to achieve better health outcomes for critically ill patients. It relies on high-quality research but usually requires additional capacity beyond clinical infrastructure. In the past, research in intensive care has mainly been led by medical staff, with several barriers existing for allied health to participate in research including workload and lack of time. Supporting already motivated AHP individuals and teams to conduct research by increasing research skills via training, infrastructure, and quarantined research time is likely to increase output and result in higher quality work. Healthcare providers must work with universities, the vocational training sector, and the government to optimise the ability of allied health to conduct research to inform best practice and influence decision-making to improve outcomes for patients.

In 2008, a health practitioner industrial agreement funded a research capacity–building initiative within Queensland Health, which included 15 new allied health research positions. These research positions most commonly developed clinicians' research skills through individual mentoring and targeted team-based education. They were reported to increase the number of clinicians engaging in research activity, and they helped clinicians build their skills in evidence-based practice to implement research evidence to improve patient care. The research positions were reported to contribute to an increase in traditional research outputs, including journal publications, national and international conference presentations, and grant funding.

This special issue of Australian Critical Care has 13 manuscripts of high quality, led by or including AHPs, and that present novel findings that will cause us to question our practice and hopefully develop further work to confirm the findings and improve the evidence base in allied health. Moreover, several represent multidisciplinary authorship groups, a process that can only serve to enrich the data and resulting publication. 

• The lead article in this issue is a multidisciplinary article titled “Earlier tracheostomy is associated with an earlier return to walking, talking and eating”, led by speech pathologist Anna-Liisa Sutt, and investigates the impact of tracheostomy timing on important patient-centred outcomes such as walking, talking, and eating in 276 patients. This is work that presents new data in an area that has been infrequently researched at this point. Additionally a national survey of the role of speech pathologists in critical care covers an area that has never been profiled before in Australia and New Zealand. 
• The special feature also includes two reviews: a narrative review that provides practical advice to clinicians regarding the assessment of nutrition status in critically ill patients and a systematic review and meta-analysis that comprehensively investigates the risk factors for post–intensive care syndrome. 
• Three articles, led by physiotherapists, investigate the impact of frailty on outcomes in trauma patients, the safety of in-bed cycling in critically ill patients, and the feasibility of exercise in patients who underwent cardiac surgery and on vasopressors. 
• Two articles, led by dietitians, firstly reports a pilot observational study of nutritional intake in noninvasively ventilated critically ill patients, and the other investigates the feasibility of an ICU specific nutrition risk score, both areas of practice with limited data currently available. 
• Also included are articles that start to explore the later period of critical illness and recovery including a multidisciplinary survey of clinicians of the barriers to rehabilitation, the feasibility, safety and functional recovery with active rehabilitation, and the patterns of movement in patients after critical illness. 

The articles in this issue support the view that allied health research is collaborative within the intensive care team and is valued for excellence, improving patient outcomes, innovations, and service efficiencies.