Physical rehabilitation in the ICU improved physical function (SMD 0.22; 95% CI 0.00-0.44) and reduced ICU length of stay (MD -0.80 days; 95% CI -1.37 to -0.23).
Meta-Analysis (n=5,352)
Does physical rehabilitation commencing in the ICU improve patient outcomes in adult ICU patients?
Physical rehabilitation in the ICU improves physical function at hospital discharge and reduces both ICU and hospital length of stay.
Estimación del efecto: SMD 0.22 (95% CI 0.00-0.44)
OBJECTIVES: Significant variability exists in physical rehabilitation modalities and dosage used in the ICU. Our objective was to investigate the effect of physical rehabilitation in ICU on patient outcomes, the impact of task-specific training, and the dose-response profile. DATA SOURCES: A systematic search of Ovid MEDLINE, Cochrane Library, EMBASE, and CINAHL plus databases was undertaken on the May 28, 2020. STUDY SELECTION: Randomized controlled trials and controlled clinical trials investigating physical rehabilitation commencing in the ICU in adults were included. Outcomes included muscle strength, physical function, duration of mechanical ventilation, ICU and hospital length of stay, mortality, and health-related quality of life. Two independent reviewers assessed titles, abstracts, and full texts against eligibility criteria. DATA EXTRACTION: Details on intervention for all groups were extracted using the template for intervention description and replication checklist. DATA SYNTHESIS: Sixty trials were included, with a total of 5,352 participants. Random-effects pooled analysis showed that physical rehabilitation improved physical function at hospital discharge (standardized mean difference, 0.22; 95% CI, 0.00–0.44), reduced ICU length of stay by 0.8 days (mean difference, –0.80 d; 95% CI, –1.37 to –0.23 d), and hospital length of stay by 1.75 days (mean difference, –1.75 d; 95% CI, –3.03 to –0.48 d). Physical rehabilitation had no impact on the other outcomes. The intervention was more effective in trials where the control group received low-dose physical rehabilitation and in trials that investigated functional exercises. CONCLUSIONS: Physical rehabilitation in the ICU improves physical function and reduces ICU and hospital length of stay. However, it does not appear to impact other outcomes.
Wang et al. (Wed,) conducted a meta-analysis in ICU patients (n=5,352). Physical rehabilitation vs. Control (including low-dose physical rehabilitation) was evaluated on Physical function at hospital discharge (SMD 0.22, 95% CI 0.00-0.44). Physical rehabilitation in the ICU improved physical function (SMD 0.22; 95% CI 0.00-0.44) and reduced ICU length of stay (MD -0.80 days; 95% CI -1.37 to -0.23).