Barbara Tempert-de Haan is a clinical physio­therapist specialized in intensive care and has been working in the ICU of the Medisch Spectrum Twente (MST) in Enschede, Netherlands, for more than 15 years. With her strong focus on early mobilisation, neuromuscular electrostim­ulation (NMES) and respiratory muscle training, she contributes to advancing physical therapy in one of Europe’s most modern non-university hospitals. In this interview, she provides insight into her daily work, technological developments, and her ongoing research projects.

Lars Timm: Dear Barbara, thank you very much for taking the time for this interview. Let’s begin with a brief introduction: Could you briefly introduce yourself to our readers? What is your profession, where do you work, and how long have you been working there?

Barbara Tempert-de Haan:I am a clinical physical therapist with a specialization in intensive care. I have been working for over 15 years in a regional hospital with both general and thoracic intensive care units. My main interests are early mobilisation of ICU patients, neuromuscular electrostimulation (NMES), and respiratory muscle training.

The ICU is a special and inspiring environment due to the complexity of the patients, the intensive teamwork, and the use of advanced technology. In recent years, I have increasingly been involved in developing physical therapy in the ICU, both in terms of content and technology. By pursuing a master’s degree and implementing various technical tools, we strive to continuously improve the care we provide.

Lars Timm: MST is considered one of the most modern non-academic hospitals in Europe. With over 1000 beds and more than 3800 employees, do you feel that the architecture and design have an impact on patient recovery?

Barbara Tempert-de Haan: Medisch Spectrum Twente in Enschede has been operating a newly designed hospital since January 2016, created as a “Healing Environment.” Elements such as light, spaciousness, colors, and furnishings are designed to support patients and their families. Each patient has their own room and bathroom, which offers a high level of privacy and comfort. This also makes it easier to encourage patient movement and carry out therapy sessions directly in the room.

Lars Timm: What does a typical workday look like in such a modern hospital? And what are the biggest differences compared to your previous workplaces?

Barbara Tempert-de Haan: We start the day by dividing patients among our team, followed by reviewing the files and planning the therapy. ICU work is highly unpredictable, so we coordinate each session closely with the responsible nurse. One of the most noticeable changes over the years has been the increasing complexity of patients and the digitization of processes. More medically complex cases require specialized treatment approaches. Where patients used to be kept sedated, they are now awake when possible, and early mobilisa­tion begins right away. This reduces muscle loss during their hospital stay. We use a variety of tools, including NMES, bed bikes, special chairs, and transfer aids. We follow national guidelines from the KNGF/NVZF, supported by MST’s own proto­cols for consistency across the team.

Lars Timm: Your clinic is located close to the German border. Do you have cross-border patient care programs, and are there any synergies with Germany?

Barbara Tempert-de Haan:ients from the entire border region, including Germany. This requires not only medical knowledge but also language and intercultural skills, especially among doctors and nurses. Generally, cross-border cooperation works well, although arranging rehabilitation after ICU discharge can be challenging. Additionally, we coop­erate with a German trauma helicopter, which is stationed near the border and used in critical cases.

Lars Timm: How do you perceive the general healthcare situation in the Netherlands, particu­larly regarding rehabilitation? Do you face similar staffing challenges as in other European countries?

Barbara Tempert-de Haan: While healthcare has improved with more investments in training and technology, there is still a significant shortage of specialized staff, especially in the ICU. Few physiotherapists specifically choose intensive care as a specialty, which unfortunately limits the devel­opment of our profession. In general, physical therapists in the Netherlands face low salaries, high workloads, and limited career perspectives — especially in outpatient settings. However, conditions in hospitals are better, with more opportunities for training and development, which currently helps maintain staffing levels in intramural care.

Lars Timm: Would you say that Dutch rehabilita­tion makes strong use of technology? What are the current challenges in your view?

Barbara Tempert-de Haan: The level of hospital-based physical therapy is reasonably high, but implementing new evidence-based practices remains time-consuming and costly. Convincing decision-makers of the importance of physical therapy can be challenging. Nevertheless, move­ment is increa­singly seen as essential to health, and some Dutch hospitals are becoming “exercise hospitals,” where all staff support patients in moving more during their stay. Technological aids like activity monitors, bed bikes, and treadmills play an important role. The biggest challenge, however, will be coping with increasing patient complexity and the growing number of in­di­viduals with low health and digital literacy. Therapy and information delivery must be adapted accordingly.

Lars Timm: In addition to your clinical work, you are also involved in research. Could you share some insight into your current and recent projects?

Barbara Tempert-de Haan:Over the past few years, I have been researching NMES in patients with ICU-acquired weakness. During the Covid pandemic, we conducted a study on the effect of NMES on the quadriceps muscle in ventilated Covid-19 patients. We applied mid-frequency stimulation for 55 minutes a day, five times a week. The results showed significantly less muscle atrophy and confirmed the method’s safety. The manuscript is currently under review.

My current research focuses on inspiratory muscle training (IMT) in long-term ventilated ICU patients. We are studying the effects of a 6-week IMT program on post-ICU physical function. While skeletal muscle training is well established, respiratory muscle rehabilitation remains underex­plored — despite the diaphragm being significantly weakened during ventilation.

Lars Timm: Can you share any early findings from this IMT study?

Barbara Tempert-de Haan: It’s still too early for definitive results, but preliminary observations suggest that patients benefit from focused inspira­tory training. More detailed outcomes will follow once data collection and analysis are complete.

Lars Timm: As you are not affiliated with a univer­sity hospital, how do you manage to conduct such research projects?

Barbara Tempert-de Haan: Initiating paramed­ical research in a non-academic hospital is complex and requires pioneering work. Our hospital board recently decided to support such efforts through a science fund, which provided a €10,000 voucher — a good start, though insufficient for a randomized controlled trial. That’s why we partnered with Amsterdam UMC and Erasmus MC for scientific and logistical support.