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Early rehabilitation to prevent postintensive care syndrome in patients with critical illness: a systematic review and meta-analysis
  1. Ryota Fuke1,
  2. Toru Hifumi2,
  3. Yutaka Kondo3,
  4. Junji Hatakeyama4,
  5. Tetsuhiro Takei,
  6. Kazuma Yamakawa5,
  7. Shigeaki Inoue6,
  8. Osamu Nishida7
  1. 1 Division of Infectious Diseases and Infection Control, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
  2. 2 Emergency Medical Center, Kagawa University Hospital, Kita-gun, Kagawa, Japan
  3. 3 Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Nakagami-gun, Okinawa, Japan
  4. 4 Department of Intensive Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
  5. 5 Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka City, Osaka, Japan
  6. 6 Department of Emergency and Critical Care Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
  7. 7 Department of Anaesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
  1. Correspondence to Dr Shigeaki Inoue; caf55000{at}


Introduction We examined the effectiveness of early rehabilitation for the prevention of postintensive care syndrome (PICS), characterised by an impaired physical, cognitive or mental health status, among survivors of critical illness.

Methods We performed a systematic literature search of several databases (Medline, Embase and Cochrane Central Register of Controlled Trials) and a manual search to identify randomised controlled trials (RCTs) comparing the effectiveness of early rehabilitation versus no early rehabilitation or standard care for the prevention of PICS. The primary outcomes were short-term physical-related, cognitive-related and mental health-related outcomes assessed during hospitalisation. The secondary outcomes were the standardised, long-term health-related quality of life scores (EuroQol 5 Dimension (EQ5D) and the Medical Outcomes Study 36-Item Short Form Health Survey Physical Function Scale (SF-36 PF)). We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate the quality of evidence (QoE).

Results Six RCTs selected from 5105 screened abstracts were included. Early rehabilitation significantly improved short-term physical-related outcomes, as indicated by an increased Medical Research Council scale score (standardised mean difference (SMD): 0.38, 95% CI 0.10 to 0.66, p=0.009) (QoE: low) and a decreased incidence of intensive care unit-acquired weakness (OR 0.42, 95% CI 0.22 to 0.82, p=0.01, QoE: low), compared with standard care or no early rehabilitation. However, the two groups did not differ in terms of cognitive-related delirium-free days (SMD: −0.02, 95% CI −0.23 to 0.20, QoE: low) and the mental health-related Hospital Anxiety and Depression Scale score (OR: 0.79, 95% CI 0.29 to 2.12, QoE: low). Early rehabilitation did not improve the long-term outcomes of PICS as characterised by EQ5D and SF-36 PF.

Conclusions Early rehabilitation improved only short-term physical-related outcomes in patients with critical illness. Additional large RCTs are needed.

  • early rehabilitation
  • intensive care unit
  • post-intensive care syndrome
  • sepsis

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • RF and TH contributed equally.

  • Contributors YK, RF, TH, JH, TT and SI conceived the idea for this systematic review. YK, RF, TH, JH, TT and SI developed the methodology for the systematic review, and KY and ON supervised the methodological process. The manuscript was drafted by YK and SI. RF, TH, JH, TT and KY, and revised by ON. All authors critically reviewed and approved the final manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Extra data can be accessed via the Dryad data repository at with the doi:10.5061/dryad.12q6c78