Table 1

Findings from 10 trials focused on post-ICU rehabilitation of critically ill patients who received mechanical ventilation

Overview of study design
Patients or study population: adult patients who have been discharged from an ICU or critical care environment during which mechanical ventilation was provided for at least 24 hours.
Setting: any.
Intervention: protocolised physical rehabilitation following ICU discharge, designed to be more intensive than the care received by the control group.
Comparison: no intervention or usual care.
Outcome Illustrative comparative risks* (95% CI) Relative effect (95% CI) No. of participants (studies) Certainty of the evidence (GRADE) Comments
Assumed riskCorresponding risk
ControlIntervention
Quality of life
Physical component summary score (6 months)
Study population 639 (4 RCTs)⊕⊕⊕⊝
Moderate
SMD: 0.06 (−0.12 to 0.24)
Quality of life
Mental component summary score (6 months)
Study population 639 (4 RCTs)⊕⊕⊕⊝
Moderate
SMD: −0.04 (−0.20 to 0.11)
Mortality
Short term (28–35 days)
Study population RR: 0.71 (0.05 to 9.80)93 (2 RCTs)⊕⊕⊝⊝
Low‡§
43 per 1000 31 per 1000 (2 to 426)
Mortality
Long term (6 months)
Study population RR: 1.05 (0.66 to 1.66)907 (5 RCTs)⊕⊕⊕⊝
Moderate
71 per 1000 75 per 1000 (47 to 119)
Adverse events Study population 153 (3 RCTs)⊕⊕⊝⊝
Low**††
Two studies reported no adverse events. One study reported 18 and 5 events in the intervention and control groups, respectively.
  • GRADE Working Group grades of evidence.

  • High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.

  • Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.

  • Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.

  • Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

  • *The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect (and its 95% CI) estimated for the intervention group.

  • †Downgraded one point because of high risk of bias associated with the lack of information regarding the dose of physical rehabilitation and adherence in the intervention group (other bias).

  • ‡Downgraded one point because of high risk of bias associated with the fact that the intervention included nutritional therapy but the study provided very little detail regarding the therapy received in the control group (other bias).

  • §Downgraded because of imprecision (only two small studies).

  • ¶Downgraded one point because of high risk of bias associated with incomplete outcome data and lack of information regarding the dose of physical rehabilitation and adherence in the intervention group, as well as with the fact that the intervention included nutritional therapy but the study provided very little detail regarding the therapy received in the control group (other bias).

  • **Downgraded one point because of high risk of bias associated with the fact that very little detail was given regarding the therapy received in the control group, and the adherence in the intervention group was 70% (other bias).

  • ††Downgraded because of imprecision (only three small studies).

  • GRADE, Grading of Recommendations Assessment, Development and Evaluation; ICU, intensive care unit; RCT, randomised controlled trial; RR, risk ratio; SMD, standardised mean difference.