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Does enhanced physical rehabilitation following intensive care unit discharge improve outcomes in patients who received mechanical ventilation? A systematic review and meta-analysis
  1. Shunsuke Taito1,
  2. Kota Yamauchi2,
  3. Yasushi Tsujimoto3,4,
  4. Masahiro Banno5,6,
  5. Hiraku Tsujimoto7,
  6. Yuki Kataoka8,9
  1. 1 Hiroshima University Hospital, Hiroshima, Japan
  2. 2 Department of Rehabilitation, Steel Memorial Yawata Hospital, Fukuoka, Japan
  3. 3 Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
  4. 4 Nephrology and Dialysis, Kyoritsu Hospital, Kawanishi, Japan
  5. 5 Department of Psychiatry, Seichiryo Hospital, Aichi, Japan
  6. 6 Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan
  7. 7 Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
  8. 8 Hospital Care Research Unit, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
  9. 9 Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
  1. Correspondence to Dr Shunsuke Taito; shutaitou{at}hiroshima-u.ac.jp

Abstract

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.

  • rehabilitation
  • critical illness
  • post-intensive care syndrome
  • exercise
  • quality of life
  • mortality

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • 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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