Impact of Nutrition Therapy and Rehabilitation on Acute and Critical Illness: A Systematic Review

Abstract

There have been no reviews describing the efficacy of the combination of both rehabilitation and nutritional treatments. This systematic review aimed to assess the effects of nutritional therapy on patients with an acute and critical illness undergoing rehabilitation. Online searches using PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, EMBASE (ELSEVIER), and Ichu-shi Web databases identified 986 articles, and 16 additional articles were found through other sources. Each trial assessed for the risk of bias using the Cochrane Collaboration's tool, and the quality of the body of evidence with The Grading of Recommendations Assessment, Development and Evaluation approach. Two randomized controlled trials were included in this review. Jones et al reported that with an enhanced rehabilitation program, there was no effect of nutritional intervention on quality of life (standardized mean difference [SMD] 0.55, 95% confidence intervals [CI]-0.05 to 1.15; P = 0.12). However, Hegerova et al reported positive effects of physical therapy and oral supplements on muscle mass (0.65; 95% CI, 0.36 to 0.93; P < 0.00001) and activities of daily living (SMD 0.28, 95% CI 0.00 to 0.56; P = 0.05). Strengthened nutritional intervention with enhanced rehabilitation treatment for patients with acute and critical illness may possibly be effective for increasing muscle mass, as well as for improving activities of daily living within a short period after discharge.

Sarcopenia in a patient with most serious complications after highly invasive surgeries treated with nutrition, rehabilitation, and pharmacotherapy: a case report

“…LBM did not change markedly in the intervention group. Two RCTs [7,8] were premised on restarting oral intake after admission [17]. In our patient, LBM improved from 29.7 kg to 38.3 kg.…”

“…Jones et al [7] did not report the total energy, total protein intake, findings, or muscle strength. Regarding the outcome data, a systematic review judged a high risk of bias due to a lack of power and follow-up for over 20% of the participants [17]. In the study by Hagerova et al [8], participants were excluded if they had weight loss recently.…”

Nutritional Interventions on Physical Functioning for Critically Ill Patients: An Integrative Review

“… 65 As suggested in a study, patients might be burdened by the nutritional treatment both during hospitalization and after discharge. 66 Considering that qualitative research could contribute to practical intervention delivery insights, this review highlights the need for more qualitative studies investigating the perspectives of the patients and/or their caregivers, in an effort to treat the person as a whole. Current qualitative studies have investigated the association between nutrition and the PF of ICU patients in either a nation (ie, Japan) 47 or certain types of ICU patients (ie, chronic critical illness patients).…”

“…Apart from nutritional interventions solely, it is recommended that bundled or synergistic therapies should be taken into consideration, 51 such as combined nutritional and physical interventions, as this enhanced synergistic treatment may increase muscle mass, and improve activities of daily living within a short period after discharge for ICU patients. 66 …”

Physical rehabilitation and critical illness

“…A recent review of nutrition and ICU rehabilitation included 2 studies which trialled oral nutritional supplementation (initiated post-ICU) combined with enhanced physical rehabilitation, and found conflicting results 6 . Future studies are indicated to determine the optimum nutrition required in both the ICU and post-ICU period, and how this can best support physical interventions.…”