Comment on Early versus delayed mobilization for in-hospital mortality and health-related quality of life among critically ill patients: a systematic review and meta-analysis (Okada et al., Journal of Intensive Care 2019)

Kuhn, Karl Friedrich; Schaller, Stefan J.

doi:10.1186/s40560-020-0436-7

Cited by 6 publications

(5 citation statements)

References 9 publications

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“… 7 , 20 ) However, recent studies have shown that initiation of rehabilitation within 48–72 h of ICU admission may be optimal. 29 ) Our previous study, which focused on the level of early rehabilitation, showed that achieving a level of mobilization higher than that of sitting on the edge of the bed within 1 week of admission to the general ICU predicts independent walking at discharge. 14 ) Other previous studies have described the effects of sitting on the edge of the bed as beneficial not only for physical function but also for respiratory and cognitive function and level of consciousness.…”

Section: Discussionmentioning

confidence: 99%

Effects of the Intensity and Activity Time of Early Rehabilitation on Activities of Daily Living Dependence in Mechanically Ventilated Patients

Watanabe

Morita

Suzuki

et al. 2021

PRM

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The aim of this study was to investigate the association between the Rehabilitation Activity Time score (RATs)-a score based on the level and duration of rehabilitation activities-of ventilated patients in the intensive care unit (ICU) and activities of daily living (ADL) dependence at discharge. Methods: This retrospective, single-center study evaluated patients aged >18 years who underwent mechanical ventilation in the ICU for at least 48 h. The patients were categorized into the low-and high-dose rehabilitation groups based on the median RATs. The primary outcome was the rate of ADL dependence at discharge, defined as a Barthel index of <70. The association between low or high doses of rehabilitation and the primary outcome was assessed using multiple logistic regression analysis adjusted by baseline factors. Results: The rate of ADL dependence at discharge was significantly lower in the high-dose rehabilitation group (low dose 81% vs. high dose 22%, P<0.001). Multivariate analysis showed a significantly lower ADL dependence at discharge among those who received high-dose rehabilitation (P<0.001). Increased RATs during the entire ICU admission period and during ICU admission after meeting the criteria for physiological stability was significantly associated with lower ADL dependence at discharge (P<0.001). Moreover, a higher RATs from low-level activity before meeting the criteria for physiological stability also showed a significant association with lower ADL dependence at discharge (P=0.047). Conclusions: ADL dependence was significantly lower among those who underwent high-dose rehabilitation. The RATs was consistently associated with ADL dependence at discharge.

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Section: Discussionmentioning

confidence: 99%

Effects of the Intensity and Activity Time of Early Rehabilitation on Activities of Daily Living Dependence in Mechanically Ventilated Patients

Watanabe

Morita

Suzuki

et al. 2021

PRM

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“…The literature includes various mobilization timings 13 , 14 ) ; however, recent studies have indicated that the initiation of mobilization within 48–72 h might be optimal. 22 ) In a previous study, EM also included passive range-of-motion exercises on the bed. 42 , 43 ) Previous studies have described improvements, not only in physical function but also in respiratory function and the level of consciousness, 44 ) as an effect of sitting on the edge of the bed.…”

Section: Discussionmentioning

confidence: 99%

“…12 ) These definitions are based on previous studies. 13 , 14 , 20 , 21 , 22 , 23 ) This single-center retrospective cohort study aimed to investigate the association between EM in the ICU and clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Effects of Mobilization among Critically Ill Patients in the Intensive Care Unit: A Single-center Retrospective Study

Watanabe

Liu

Morita

et al. 2022

PRM

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Objectives: This study investigated the effect of early mobilization [EM; physical rehabilitation with the intensity needed to sit on the edge of the bed started within 5 days of intensive care unit (ICU) admission] in relation to improvements in gait independence and other clinical outcomes. Methods: This retrospective single-center study evaluated patients aged at least 18 years who stayed in the ICU for at least 48 h and were categorized into EM and late mobilization (LM; physical rehabilitation started more than 5 days after ICU admission) groups. Outcomes were compared after adjusting for 20 background factors by propensity score matching and inverse probability of treatment weighting. The primary outcome was independent gait at discharge. The secondary outcomes were medical costs, 90-day survival, and durations of ICU and hospital stays. Results: Of 177 patients, 85 and 92 were enrolled in the EM and LM groups, respectively. Propensity score matching created 37 patient pairs. There was no significant difference in the 90-day survival rate (P=0.308) or medical costs (P=0.054), whereas independent gait at discharge (P=0.025) and duration of hospital stay (P=0.013) differed significantly. Multivariate logistic regression analysis showed that EM was independently associated with independent gait at discharge (P=0.011) and duration of hospital stay (P=0.010) but was not associated with 90-day survival (odds ratio: 2.64, 95% confidence interval: 0.67–13.12, P=0.169). Conclusions: Early mobilization in the ICU did not affect 90-day survival and did not lower medical costs but was associated with independent gait at discharge and shorter hospital stays.

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“…Only RCTs involving critically ill adult (≥18 years) patients admitted to the ICU were included in the study. Interventions were defined as early mobilization initiated within 72 h of ICU admission or earlier than that conducted in the control group [ 12 ]. Studies using only neuromuscular electrical stimulation or ergometers were excluded.…”

Section: Methodsmentioning

confidence: 99%

Effects of Mobilization within 72 h of ICU Admission in Critically Ill Patients: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

Matsuoka,

Yoshihiro,

Shida

et al. 2023

JCM

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Previous systematic review and meta-analysis indicates that rehabilitation within a week of intensive care unit (ICU) admission benefits physical function in critically ill patients. This updated systematic review and meta-analysis aim to clarify effects of initiating rehabilitation within 72 h of ICU admission on long-term physical, cognitive, and mental health. We systematically searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi for randomized controlled trials (RCTs) between April 2019 and November 2022 to add to the previous review. Two investigators independently selected and extracted data. Pooled effect estimates for muscle strength, cognitive function, mental health after discharge, and adverse events were calculated. Evidence certainty was assessed via Grading of Recommendations, Assessment, Development, and Evaluations. Eleven RCTs were included in the meta-analysis. Early rehabilitation may improve muscle strength (three trials; standard mean difference [SMD], 0.16; 95% confidence interval [CI], −0.04–0.36) and cognitive function (two trials; SMD, 0.54; 95% CI, −0.13–1.20). Contrastingly, early mobilization showed limited impact on mental health or adverse events. In summary, initiating rehabilitation for critically ill patients within 72 h may improve physical and cognitive function to prevent post-intensive care syndrome without increasing adverse events. The effect on mental function remains uncertain.

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Comment on Early versus delayed mobilization for in-hospital mortality and health-related quality of life among critically ill patients: a systematic review and meta-analysis (Okada et al., Journal of Intensive Care 2019)

Abstract: Critical comment on the review by Okada et al. on the effect of early versus delayed mobilization because of their definition of early mobilization as mobilization within a week of ICU admission in contrast to current evidence.

Cited by 6 publications

References 9 publications

Effects of the Intensity and Activity Time of Early Rehabilitation on Activities of Daily Living Dependence in Mechanically Ventilated Patients

Effects of the Intensity and Activity Time of Early Rehabilitation on Activities of Daily Living Dependence in Mechanically Ventilated Patients

Effects of Mobilization among Critically Ill Patients in the Intensive Care Unit: A Single-center Retrospective Study

Effects of Mobilization within 72 h of ICU Admission in Critically Ill Patients: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

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