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

Autor:	Wang YT; School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia.; Department of Physiotherapy, Peninsula Health, Melbourne, VIC, Australia., Lang JK; Department of Physiotherapy, Western Health, Melbourne, VIC, Australia., Haines KJ; Department of Physiotherapy, Western Health, Melbourne, VIC, Australia.; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia., Skinner EH; School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia.; Department of Physiotherapy, Western Health, Melbourne, VIC, Australia., Haines TP; School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia.; National Centre for Healthy Ageing, Monash University, Melbourne, VIC, Australia.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2022 Mar 01; Vol. 50 (3), pp. 375-388.
DOI:	10.1097/CCM.0000000000005285
Abstrakt:	Objectives: 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. Data Sources: A systematic search of Ovid MEDLINE, Cochrane Library, EMBASE, and CINAHL plus databases was undertaken on the May 28, 2020. Study Selection: Randomized controlled trials and controlled clinical trials investigating physical rehabilitation commencing in the ICU in adults were included. Outcomes included muscle strength, physical function, duration of mechanical ventilation, ICU and hospital length of stay, mortality, and health-related quality of life. Two independent reviewers assessed titles, abstracts, and full texts against eligibility criteria. Data Extraction: Details on intervention for all groups were extracted using the template for intervention description and replication checklist. Data Synthesis: Sixty trials were included, with a total of 5,352 participants. Random-effects pooled analysis showed that physical rehabilitation improved physical function at hospital discharge (standardized mean difference, 0.22; 95% CI, 0.00-0.44), reduced ICU length of stay by 0.8 days (mean difference, -0.80 d; 95% CI, -1.37 to -0.23 d), and hospital length of stay by 1.75 days (mean difference, -1.75 d; 95% CI, -3.03 to -0.48 d). Physical rehabilitation had no impact on the other outcomes. The intervention was more effective in trials where the control group received low-dose physical rehabilitation and in trials that investigated functional exercises. Conclusions: Physical rehabilitation in the ICU improves physical function and reduces ICU and hospital length of stay. However, it does not appear to impact other outcomes. Competing Interests: Mr. Wang received funding from the Australian Postgraduate Award. Dr. Skinner’s institution (Western Health) received funding from the Australian Institute of Musculoskeletal Science. Prof. T. P. Haines received funding from K&L Gates Law Firm and Minter Ellison Law Firm. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
Databáze:	MEDLINE
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