Taking ground-breaking research in ICU physiotherapy to the world

Professor Carol Hodgson
Doctor of Philosophy
Department of Physiotherapy

Early in her career as a graduate physiotherapist, Professor Carol Hodgson fell in love with intensive care. It was during her first job in a public hospital, while working in a large multidisciplinary team, that she began to appreciate the coordination of care, the fast pace and the complex decision-making this work entailed. “I knew it was an area I wanted to work in and as soon as my junior rotations were over, I attained a position as a senior physiotherapist in ICU,” she says.

Professor Hodgson went on to specialise in ICU physiotherapy, becoming one of only a handful of cardiorespiratory physiotherapists in Australia. She is also one of the few physiotherapists in the world to sit on international panels to develop guidelines for mechanical ventilation for acute respiratory failure – an issue that has been of particular relevance during the COVID-19 pandemic. “It’s a privilege to be able to contribute that way and to be an ambassador for our profession,” she says.

Professor Hodgson loves the challenge of intensive care, which often requires dealing with multiple systems of the body, and involves complex diagnoses and medical management. The work also requires strong mutual respect among clinicians. “The physiology and the stability of the patient is critical, so the assessment is aligned with the medical and nursing team and you work closely with them,” she says. “The goals of care are interdisciplinary and the medical and nursing staff really value our opinion, not just on mobilisation and exercise, but also on weaning from mechanical ventilation and the role of non-invasive ventilation.”

Research soon beckoned: “I met some fabulous mentors along the way who were doing their own research in the field and encouraged me to ask questions,” Professor Hodgson says. “I started to wonder if there were better ways of treating patients and whether our interventions were beneficial – and how did we know if we weren’t monitoring outcomes?” A stint in the UK further piqued her interest in the international work being done in physiotherapy and compelled her to continue down a research pathway at Monash University, investigating early mobilisation to minimise weakness in intensive care.

Professor Hodgson’s postgraduate studies coincided with the start of family life – she had four children in four years and found herself working on her research whenever she could. “I loved it – it was the one thing in my life I was doing just for me. It meant several years of grabbing a couple of hours to work while toddlers were napping, or going into hospital while the kids were asleep to pull an all-nighter, and collecting my degree with little ones under each arm.”

“The Peninsula campus was really new, the grounds were lovely and it was an opportunity to focus on my work without interruption. We had access to wonderful facilities and childcare if I needed it,” she says. “My supervisor, Jenny Keating, was brilliant and had a major impact on my career – I will be forever grateful for her faith in me.”

Professor Hodgson has worked for the last decade at the Australia and New Zealand Intensive Care Research Centre, in the School of Public Health and Preventive Medicine, where she is now leading a national trial on early mobilisation to prevent muscle weakness in intensive care.

The trial, which is due to wind up in the coming months, involves moving critically ill patients within 72 hours of mechanical ventilation, to record the results of early activity and mobilisation. Sedation needs to be decreased or stopped to allow the patient to interact and move, where appropriate, and to have these mechanically ventilated patients sitting, walking and moving.

“This is a trial where we really could make a difference to patient care,” says Professor Hodgson. "If you leave patients lying in bed, their muscles will waste rapidly – the composition of the muscles changes and this can affect the patient’s strength in the future.” Professor Hodgson hopes that this research will be a major publication in the field worldwide.

The pandemic has increased Professor Hodgson’s workload, both clinically and in a research capacity. She and her colleagues have been leading the COVID-19 research across Australia and around the world with studies into long-term effects of critically ill COVID-19 patients, which examine the role physiotherapy interventions can play.

Another recent achievement is the funding Professor Hodgson has secured from the NHMRC for a new Centre of Research Excellence to Transform Outcomes of Critically Ill Patients in ICU. She sees this as an excellent opportunity to build researcher capacity at a time when ICU has been in the global spotlight.

Professor Hodgson marvels at the growth of the Department of Physiotherapy at Monash since she was a PhD candidate. “The Monash graduates who come and work with us at the Alfred are, in my opinion, the cream of the crop. They possess great clinical decision-making, prioritisation and organisation skills and great communication. I think the Monash Department of Physiotherapy is exemplary.”

“My advice to aspiring students in the field is to work in an area you love and to choose your mentors wisely,” she says. “Throughout my career, I have had multiple mentors over time, from outside the profession as well as within it. Those in the physiotherapy profession have helped me to step outside my comfort zone, to be brave in my career choices and to embrace change.” The other piece of advice she shares is to collaborate widely: “We are well valued in the medical community and have the ability to collaborate not only locally but on large national and international projects and I think that’s definitely been the highlight of my career – to have these wonderful international collaborations and partnerships.”