Physical rehabilitation interventions for adult patients during critical illness: an overview of systematic reviews

Abstract

BackgroundPhysical rehabilitation interventions aim to ameliorate the effects of critical illness-associated muscle dysfunction in survivors. We conducted an overview of systematic reviews (SR) evaluating the effect of these interventions across the continuum of recovery.MethodsSix electronic databases (Cochrane Library, CENTRAL, DARE, Medline, Embase, and Cinahl) were searched. Two review authors independently screened articles for eligibility and conducted data extraction and quality appraisal. Reporting quality was assessed and the Grading of Recommendations Assessment, Development and Evaluation approach applied to summarise overall quality of evidence.ResultsFive eligible SR were included in this overview, of which three included meta-analyses. Reporting quality of the reviews was judged as medium to high. Two reviews reported moderate-to-high quality evidence of the beneficial effects of physical therapy commencing during intensive care unit (ICU) admission in improving critical illness polyneuropathy/myopathy, quality of life, mortality and healthcare utilisation. These interventions included early mobilisation, cycle ergometry and electrical muscle stimulation. Two reviews reported very low to low quality evidence of the beneficial effects of electrical muscle stimulation delivered in the ICU for improving muscle strength, muscle structure and critical illness polyneuropathy/myopathy. One review reported that due to a lack of good quality randomised controlled trials and inconsistency in measuring outcomes, there was insufficient evidence to support beneficial effects from physical rehabilitation delivered post-ICU discharge.ConclusionsPatients derive short-term benefits from physical rehabilitation delivered during ICU admission. Further robust trials of electrical muscle stimulation in the ICU and rehabilitation delivered following ICU discharge are needed to determine the long-term impact on patient care. This overview provides recommendations for design of future interventional trials and SR.Trial registration numberCRD42015001068.

Exercise rehabilitation following intensive care unit discharge for recovery from critical illness: executive summary of a Cochrane Collaboration systematic review

“…Adjunctive technologies including electrical muscle stimulation and cycle ergometry may also be employed. The safety and feasibility of early mobilization have been well documented, and its efficacy has been examined in a number of systematic reviews demonstrating significant benefit in health‐related quality of life, physical function, respiratory and peripheral skeletal muscle strength, length of ICU and hospital stay, and duration of mechanical ventilation . However, the post‐ICU discharge stages of recovery have been relatively under‐examined, and given the residual impairments in physical function evident in ICU survivors, there is rationale for the ongoing delivery of exercise‐based rehabilitation interventions …”

“…The safety and feasibility of early mobilization have been well documented, [24][25][26][27][28] and its efficacy has been examined in a number of systematic reviews demonstrating significant benefit in health-related quality of life, physical function, respiratory and peripheral skeletal muscle strength, length of ICU and hospital stay, and duration of mechanical ventilation. [29][30][31][32] However, the post-ICU discharge stages of recovery have been relatively under-examined, and given the residual impairments in physical function evident in ICU survivors, there is rationale for the ongoing delivery of exercise-based rehabilitation interventions. 30 This paper provides an executive summary of a recent Cochrane Collaboration systematic review, 33 which synthesizes evidence for exercise-based rehabilitation initiated after ICU discharge.…”

“…[29][30][31][32] However, the post-ICU discharge stages of recovery have been relatively under-examined, and given the residual impairments in physical function evident in ICU survivors, there is rationale for the ongoing delivery of exercise-based rehabilitation interventions. 30 This paper provides an executive summary of a recent Cochrane Collaboration systematic review, 33 which synthesizes evidence for exercise-based rehabilitation initiated after ICU discharge. The aim was to determine the effectiveness of exercise-based rehabilitation, compared with usual care, on primary outcomes of functional exercise capacity and health-related quality of life in survivors of critical illness.…”

Volitional rehabilitative assessments in patients admitted in a post-intensive care step down unit. A feasibility study

“…Previous reports have shown that rehabilitation in this population is safe and feasible, involving respiratory muscle strength, limb and arm muscles strength, activities of daily living (ADL) functional scores and effort tolerance [5][6][7][8]. Two recent reviews by Elliot et al [9] and Connolly et al [10] describe a high variability in muscle strength evaluations, functional activity tests, walking assessments, and patient-centered outcomes such as healthrelated quality of life in survivors of ICU. The Authors conclude that sensitivity and validity of measures in survivors of a critical illness have not yet been established and new tools need to be developed to appropriately assess the weakness and poor physical function in order to measure effectiveness of interventions [9,10].…”

“…Two recent reviews by Elliot et al [9] and Connolly et al [10] describe a high variability in muscle strength evaluations, functional activity tests, walking assessments, and patient-centered outcomes such as healthrelated quality of life in survivors of ICU. The Authors conclude that sensitivity and validity of measures in survivors of a critical illness have not yet been established and new tools need to be developed to appropriately assess the weakness and poor physical function in order to measure effectiveness of interventions [9,10]. In fact, the majority of studies carried out take into consideration only some aspects of patient's disability, but no study has performed a comprehensive and objective rehabilitative assessment with the most common measures used in this field to detect their feasibility.…”