Physiotherapy EPA5 Positioning and Rehabilitation

The novice physiotherapist will be able to complete a musculoskeletal assessment including range of movement, sensation and a strength assessment and determine the risk of developing physical morbidity.

The novice physiotherapist will be able to implement a rehabilitation plan meets the needs of the patient and their goals.

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You can print this EPA in a completable template by clicking print below.

If you select any prior completed EPAs via the options below the printable form will automatically mark these as "achieved".

EPA overview information
Required knowledge

Competencies Required:

  • C3Framework Shared AHP Competencies
  • C3Framework Core Competencies:
    • Competency 1 Assessment
    • Competency 5 Positioning and Rehabilitation
Suggested reading
  • NICE CG83: Rehabilitation after critical illness in adults (2009)
  • The Chelsea Critical Care Physical Assessment Tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study. Physiotherapy - March 2013 (Vol. 99, Issue 1, Pages 33-41, DOI: 10.1016/ E.J. Corner, H. Wood, C. Englebretsen, A. Thomas, R.L. Grant, D. Nikoletou, N. Soni
Information to assess progression
  • Clinical supervision
  • Nonclinical supervision
  • Notes Audit
Basis for formal entrustment decisions

An entrustment decision should be made by an experienced critical care physiotherapist after observing this EPA completed on more than one patient.

Use the EPA Completion Template (PDF, 88KB) for this.

Previously completed EPAs:
If you have completed any previous EPAs, select them here
to highlight where competencies have already been met.

Shared AHP competencies

Competency description Self assessment Senior assessment


Infection Prevention and Control:

Able to demonstrate knowledge of general infection control prevention and control including hand hygiene, aprons, masks and aseptic non-touch technique


Patient Emergency Management:

Has completed Basic Life Support Training as per local trust policy


Describes how they would summon help in an emergency and locate crash bells


Describes how to call a medical emergency call via switch


Describes own role and expected contribution in medical emergency eg. Basic Life Support, providing assistance to MDT as able


Patient ID:

Demonstrates positive patient identification and awareness of allergies


Monitoring Vital Signs:

Demonstrates how to monitor vital signs (Temp, HR, SpO2, RR, blood pressure, MAP)


Interprets observations in an ICU setting, considering trends and normal ranges for all (Temp, HR, SpO2, RR, blood pressure)


Able to troubleshoot difficulties with taking vital signs eg. poor trace on pulse oximeter, missing ECG leads, positional sensitivity of arterial line


Awareness of who to escalate concerns to in relation to patient safety with recognition of different levels of urgency and reporting to different staff members dependent on situation



Can describe the bed numbering, storage location of safety equipment, location of offices and other key areas within the critical care unit


Can describe the shift patterns and handover process of other MDT members


Able to identify key MDT members by their role, including critical care nurses, nurse in charge, consultant on call


Demonstrates how to locate the local protocols and guidelines relevant to own role


Has an awareness of key ICU meetings relevant to role e.g. MDT meetings, handovers, safety briefings, teaching sessions.


Can identify standard ICU bedspace equipment and location of equipment necessary for role



Communication with patient:

Describe barriers to communication in ICU including those associated with PPE, illness and ICU interventions.


Awareness of communication aids with patients to overcome communication barriers i.e. PPE + oral intubation


Communication with family + friends:

Describe the support services available to help liaise with family including family support nurses, PALS, psychology services as appropriate.


Describe barriers to communication with family and methods to improve this


Knows importance of confidentiality and consent to share information with friends and family


Communication with colleagues:

Awareness of peer support and psychological support



Local IT Training:

Demonstrates how to access and document in patient records using local IT systems


Demonstrates how to view results and imaging on local IT systems


Moving and Handling

Awareness of Falls prevention and who to escalate to if concerned regarding falls risks


Compliant with Manual Handling training as per local trust policy.


Non-technical skills


Demonstrate working in an MDT by building and maintaining relationships with other professions


Aware of the roles and responsibilities of other members of the MDT


Clarifies, accepts and executes tasks delegated by the team leader


Explains the importance of highlighting safety issues / concerns to a member of your team in a prompt manner


Uses appropriate level of assertiveness for the clinical situation


Demonstrates a logical and systematic handover using local format


Outline how to escalate and to whom if there are patient / safety concerns


Identify and respond to patient / staff safety issues appropriately


Clinical Assessment and Basic Life Support


Demonstrate ways to open up airway using simple manoeuvres (inc. repositioning, head tilt chin lift, jaw thrust)


Demonstrates how to deliver manual ventilation using two person bag-valve-mask (BVM) technique


Recognise and escalate airway compromise in a tracheostomised patient


Mouth care:

Demonstrates how to perform and document oral hygiene



Knows the types of oxygen delivery system and their limitations (including reservoir mask, simple face mask, venturi system and nasal cannulae)


Demonstrates how to deliver oxygen urgently (including reservoir mask, simple face mask, venturi system and nasal cannulae)


Describe how to escalate or de-escalate oxygen therapy in a step wise manner eg. nasal cannulae to face mask.


Lines and attachments:

Recognise different lines and their location relevant to local population (eg arterial lines, central line, vas-cath)



Identify enteral feeding tube in situ, whether it is connected to feed and whether the feed pump is running


Knows to discuss plans with nursing staff prior to moving or reposition a patient with NG feed running


Aware of events which can displace feeding tubes and to escalate accordingly


Describes how to check enteral feeding length and escalates if tube length has changed


Describe how to recognise dysphagia and an escalation plan including referral to SLT


Demonstrates how to assist patients with eating and drinking


Have an awareness of modified diets or thickened fluids in line with SLT recommendations



Demonstrate how to categorise neurological status using the AVPU scoring


Describe factors that may cause or contribute to delirium


Describes how to recognise delirium


Demonstrates how to complete a CAM-ICU score


Demonstrates an understanding of non-pharmacological management of delirium


Demonstrates knowledge of the Mental Capacity Act, when capacity assessment is indicated, how to assess capacity and when specialist communication support is required eg. referral to SLT



Demonstrates how to use pain faces or a similar visual analog scale


Demonstrates an understanding on the impact of pain on patient presentation eg. agitation


Demonstrates an understanding of the impact of pain medication on patient presentation eg. sedative effect



Demonstrates an understanding of RASS (or alternative sedation) scoring system


Able to access and read using ICU drug charts


Demonstrates an awareness of common ICU sedative medications


Demonstrates a basic knowledge of common ICU medications and their role e.g. sedatives, vasopressors, inotropes


Core competencies

Competency description Self assessment Senior assessment


Explains physiotherapy role to patients and family


Acquires consent for assessment and treatment or understands when to “treat in best interest”


Ascertains the presenting condition and relevant medical and social history to inform assessment and goal setting


Ascertains limitations of treatment (e.g. resuscitation status, End of life pathway)



Identifies type of airway, airway adjuncts and patency

  • Own
  • Naso Pharyngeal (NP)
  • Endo tracheal tube (ETT)
  • Tracheostomy

Awareness of grades of Intubation and measures taken to secure ETT



Identifies the oxygen delivery device, flow rate and FiO2


Ability to interpret vital signs from bedside monitoring equipment including respiratory rate, and saturations


Auscultates patient and describes breath sounds and added sounds


Observes and describes breathing pattern and chest wall movement


Assesses cough and describes effectiveness


Interprets a CXRAY, completing a systematic assessment identifying volume loss, consolidation, pneumothorax, pleural effusions and pulmonary oedema.


Interprets blood gases demonstrating knowledge of parameters appropriate for the patient


Able to identify mucolytics, bronchodilators and antibiotics within a prescription chart


Mechanically Ventilated Patients:


Identifies the mode of ventilation and can interpret set parameters including PEEP, inspiratory support, I to E ratio and fio2


Awareness of spontaneous modes, controlled modes and mixed modes of ventilation.


Able to identify tidal volumes, peak airway pressures and aware of safe limits



Interprets vital signs from bedside monitoring including heart rate and rhythm.


Identifies systolic and diastolic pressure and recognise a poor arterial trace


Interprets cardiac monitoring demonstrating knowledge of parameters appropriate for the patient.


Able to identify commonly used cardiac drugs within a prescription chart



Able to complete an accurate assessment of level of consciousness using AVPU or GCS


Able to understand the RASS scoring system in the sedated patient


Recognises Delirium scoring system and can describe methods to reduce delirium


Able to identify commonly used medications to reduce agitation and ones that may affect level of consciousness



Identifies and explain the indication for Chest drains and comment on their status (swinging/bubbling/on suction)


Identifies and explain the indication for a PCA (Patient controlled analgesic)


Identifies the urinary catheter or filter for Renal replacement therapy



Identifies and explain rationale for NG tube and completes the 4 checks for safety



Identifies abnormal blood results and describes their potential impact on physiotherapy treatment.


HB, Platelets, INR, APTT, K+, CRP, WCC, NA, Urea, Creatinine and Albumin


Clinical Reasoning:

Forms a problem list informed by the holistic patient assessment with and understanding of which problems are amenable to physiotherapy intervention



Assessment for rehabilitation

PMH review to ascertain baseline


Able to recognise parameters indicating readiness to start rehabilitation


Ability to complete a Musculoskeletal assessment using a standardised objective measure such as Oxford grading scale for muscle strength


Can document AROM, AAROM and PROM accurately


Transfers and mobility

Can assist a patient to sit over the edge of the bed and safely manage the attachments


Can assess physiological tolerance of this manoeuvre and accurately describe the levels of assistance provided


Can assist a patient from sitting over the edge of the bed to standing and safely manage the attachments


Can assess physiological tolerance of this manoeuvre and accurately describe the levels of assistance provided


Can mobilise a patient and safely change the attachments


Can select appropriate seating with regards to levels of support and width and weight requirement


Can assist with rolling a patient to insert a hoist sling


Can lead hoisting to a chair ensuring lines are moved appropriately


Can assess physiological tolerance of sitting


Outcome measures

Demonstrates awareness of commonly used outcome measures in ACCU within therapy - CPAx score, PICCUPS tool