Physical Rehabilitation in the ICU: A Systematic Review and Meta-Analysis*

Wang, Yi Tian; Lang, Jenna; Haines, Kimberley; Skinner, Elizabeth H; Haines, Terry

doi:10.1097/ccm.0000000000005285

Cited by 72 publications

(58 citation statements)

References 113 publications

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“…Compared to 2011, by 2026, it is estimated that the demand for ICU services will increase by 40%, and more survivors will have post-ICU disability 83. Systematic reviews of ICU physical rehabilitation trials have reported discordant results for the effectiveness of these interventions 67 84. Given anticipated increases in required critical care services, the need is pressing to identify effective ICU rehabilitation strategies that mitigate post-ICU morbidity.…”

Section: Discussionmentioning

confidence: 99%

Critical Care Cycling to ImproveLowerExtremity Strength (CYCLE): protocol for an international, multicentre randomised clinical trial of early in-bed cycling for mechanically ventilated patients

et al. 2023

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IntroductionIn-bed leg cycling with critically ill patients is a promising intervention aimed at minimising immobility, thus improving physical function following intensive care unit (ICU) discharge. We previously completed a pilot randomised controlled trial (RCT) which supported the feasibility of a large RCT. In this report, we describe the protocol for an international, multicentre RCT to determine the effectiveness of early in-bed cycling versus routine physiotherapy (PT) in critically ill, mechanically ventilated adults.Methods and analysisWe report a parallel group RCT of 360 patients in 17 medical-surgical ICUs and three countries. We include adults (≥18 years old), who could ambulate independently before their critical illness (with or without a gait aid), ≤4 days of invasive mechanical ventilation and ≤7 days ICU length of stay, and an expected additional 2-day ICU stay, and who do not fulfil any of the exclusion criteria. After obtaining informed consent, patients are randomised using a web-based, centralised system to either 30 min of in-bed cycling in addition to routine PT, 5 days per week, up to 28 days maximum, or routine PT alone. The primary outcome is the Physical Function ICU Test-scored (PFIT-s) at 3 days post-ICU discharge measured by assessors blinded to treatment allocation. Participants, ICU clinicians and research coordinators are not blinded to group assignment. Our sample size estimate was based on the identification of a 1-point mean difference in PFIT-s between groups.Ethics and disseminationCritical Care Cycling to improveLowerExtremity (CYCLE) is approved by the Research Ethics Boards of all participating centres and Clinical Trials Ontario (Project 1345). We will disseminate trial results through publications and conference presentations.Trial registration numberNCT03471247(Full RCT);NCT02377830(CYCLE Vanguard 46 patient internal pilot).

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Section: Discussionmentioning

confidence: 99%

Critical Care Cycling to ImproveLowerExtremity Strength (CYCLE): protocol for an international, multicentre randomised clinical trial of early in-bed cycling for mechanically ventilated patients

et al. 2023

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“…Early mobilization is one of the most widely used physical rehabilitation interventions in both adult and pediatric critically ill patients used to improve peripheral and respiratory physical functioning, including progressive mobility, passive or active range of motion exercises, respiratory muscle training, cycle ergometry, and neuromuscular (NMES) or functional electrostimulation (FES) [15][16][17]. Early mobilization is safe [18], and some primary studies have reported its positive effect on physical functioning and delirium [19], and to reduce ICU and hospital length of stay [20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of physical rehabilitation interventions in critically ill patients—A protocol for an overview of systematic reviews

et al. 2023

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Introduction Adult and pediatric patients admitted to intensive care units (ICUs) requiring invasive ventilatory support, sedation, and muscle blockade may present neuromusculoskeletal deterioration. Different physical rehabilitation interventions have been studied to evaluate their effectiveness in improving critically ill patients’ outcomes. Given that many published systematic reviews (SRs) aims to determine the effectiveness of different types of physical rehabilitation interventions, it is necessary to group them systematically and assess the methodological quality of SRs to help clinicians make better evidence-based decisions. This overview of SRs (OoSRs) aims to map the existing evidence and to determine the effectiveness of physical rehabilitation interventions to improve neuromusculoskeletal function and other clinical outcomes in adult and pediatric critically ill patients. Methods An OoSRs of randomized and non-randomized clinical trials involving critically ill adult and pediatric patients receiving physical rehabilitation intervention will be conducted. A sensitive search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos, and other search resources will be conducted. Two independent reviewers will conduct study selection, data extraction, and methodological quality assessment. Discrepancies will be resolved by consensus or a third reviewer. The degree of overlap of studies will be calculated using the corrected covered area. The methodological quality of the SRs will be measured using the AMSTAR-2 tool. The GRADE framework will report the certainty of evidence by selecting the "best" SR for each physical rehabilitation intervention and outcome. Discussion The findings of this overview are expected to determine the effectiveness and safety of physical rehabilitation interventions to improve neuromusculoskeletal function in adult and pediatric critically ill patients based on a wide selection of the best available evidence and to determine the knowledge gaps in this topic by mapping and assessing the methodological quality of published SRs. Registration number CRD42023389672.

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“…In the past decade, research has predominantly focused on establishing the evidence for physical therapy and/or nutrition therapy during critical illness -as distinct and separate interventions [1,2]. Until recently, there has been limited investigation into how these interventions interact and whether they are in fact, synergistic, antagonistic, or independent.…”

Section: Introductionmentioning

confidence: 99%

Physical therapy and nutrition therapy: synergistic, antagonistic, or independent interventions?

Haines

Emery

Berney

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewPhysical therapy and nutrition therapy have predominantly been studied separately in the critically ill, however in clinical practice are often delivered in combination. It is important to understand how these interventions interact. This review will summarize the current science – where they are potentially synergistic, antagonistic, or independent interventions.Recent findingsOnly six studies were identified within the ICU setting that combined physical therapy and nutrition therapy. The majority of these were randomized controlled trials with modest sample sizes. There was an indication of benefit in the preservation of femoral muscle mass and short-term physical quality of life - particularly with high-protein delivery and resistance exercise, in patients who were predominantly mechanically ventilated patients, with an ICU length of stay of approximately 4–7 days (varied across studies). Although these benefits did not extend to other outcomes such as reduced length of ventilation, ICU or hospital admission. No recent trials were identified that combined physical therapy and nutrition therapy in post-ICU settings and is an area that warrants investigation.SummaryThe combination of physical therapy and nutrition therapy might be synergistic when evaluated within the ICU setting. However, more careful work is required to understand the physiological challenges in the delivery of these interventions. Combining these interventions in post-ICU settings is currently under-investigated, but may be important to understand any potential benefits to patient longitudinal recovery.

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Physical Rehabilitation in the ICU: A Systematic Review and Meta-Analysis*

Abstract: Significant variability exists in physical rehabilitation modalities and dosage used in the ICU. Our objective was to investigate the effect of physical rehabilitation in ICU on patient outcomes, the impact of task-specific training, and the dose-response profile.

Cited by 72 publications

References 113 publications

Critical Care Cycling to ImproveLowerExtremity Strength (CYCLE): protocol for an international, multicentre randomised clinical trial of early in-bed cycling for mechanically ventilated patients

Critical Care Cycling to ImproveLowerExtremity Strength (CYCLE): protocol for an international, multicentre randomised clinical trial of early in-bed cycling for mechanically ventilated patients

Effectiveness of physical rehabilitation interventions in critically ill patients—A protocol for an overview of systematic reviews

Physical therapy and nutrition therapy: synergistic, antagonistic, or independent interventions?

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