Objective We aimed to determine whether enhanced physical rehabilitation following intensive care unit (ICU) discharge improves activities-of-daily-living function, quality of life (QOL) and mortality among patients who received mechanical ventilation in the ICU.
Design Systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Data sources MEDLINE, Embase, CENTRAL, PEDro and WHO International Clinical Trials Registry Platform searched through January 2019.
Eligibility criteria for selecting studies We included randomised controlled trials assessing the effect of post-ICU rehabilitation designed to either commence earlier and/or be more intensive than the protocol employed in the control group. Only adults who received mechanical ventilation for >24 hours were included.
Data extraction and synthesis Two independent reviewers extracted data and assessed risk of bias. Standard mean differences (SMDs) with 95% CIs were calculated for QOL, and pooled risk ratios (RRs) with 95% CIs are provided for mortality. We assessed heterogeneity based on I² and the certainty of evidence based on the GRADE approach.
Results Ten trials (enrolling 1110 patients) compared physical rehabilitation with usual care or no intervention after ICU discharge. Regarding QOL, the SMD (95% CI) between the intervention and control groups for the physical and mental component summary scores was 0.06 (–0.12 to 0.24) and −0.04 (−0.20 to 0.11), respectively. Rehabilitation did not significantly decrease long-term mortality (RR 1.05, 95% CI 0.66 to 1.66). The analysed trials did not report activities-of-daily-living data. The certainty of the evidence for QOL and mortality was moderate.
Conclusions Enhanced physical rehabilitation following ICU discharge may make little or no difference to QOL or mortality among patients who received mechanical ventilation in the ICU. Given the wide CIs, further studies are needed to confirm the efficacy of intensive post-ICU rehabilitation in selected populations.
PROSPERO registration number CRD42017080532.
- critical illness
- post-intensive care syndrome
- quality of life
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Contributors ST and KY designed the study, were involved in the systematic review process, analysed and interpreted the data and drafted the manuscript. MB, HT, YK and YT participated in the systematic review process, critically reviewed the initial manuscript and approved the final manuscript as submitted. All authors read and approved the final manuscript.
Funding This work was supported by JSPS KAKENHI Grant Number JP18K17719.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data associated with this manuscript are included in the main text and supplementary materials.
Patient consent for publication Obtained.
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