Data from: Early rehabilitation to prevent post-intensive care syndrome in critically ill patients: a systematic review and meta-analysis

Introduction: We examined the effectiveness of early rehabilitation for
the prevention of post-intensive care syndrome (PICS), characterised by an
impaired physical, cognitive, or mental health status, among survivors of
critical illness. Methods: We performed a systematic literature search of
several databases (Medline, Embase, and Cochrane Central Register of
Controlled Trials) and a manual search to identify randomised controlled
trials (RCTs) comparing the effectiveness of early rehabilitation versus
no early rehabilitation or standard care for the prevention of PICS. The
primary outcomes were short-term physical-, cognitive-, and mental
health-related outcomes assessed during hospitalisation. The secondary
outcomes were the standardised, long-term health-related quality of life
scores (EuroQol 5 Dimension [EQ5D] and the Medical Outcomes Study 36-Item
Short Form Health Survey Physical Function scale [SF-36 PF]). We used the
Grading of Recommendations Assessment, Development and Evaluation (GRADE)
approach to rate the quality of evidence (QoE). Results: Six RCTs selected
from 5,105 screened abstracts were included. Early rehabilitation
significantly improved short-term physical-related outcomes, as indicated
by an increased Medical Research Council scale score (MRC score)
[standardised mean difference (SMD): 0.38, 95% confidence interval (CI):
0.10–0.66, p = 0.009] (QoE: low) and a decreased incidence of ICU-acquired
weakness (ICU-AW) [odds ratio (OR) 0.42, 95% CI 0.22 to 0.82, p = 0.01]
(QoE: low), compared to standard care or no early rehabilitation. However,
the two groups did not differ in terms of cognitive-related delirium-free
days (SMD: -0.02, 95% CI: -0.23–0.20) (QoE: low) and the mental
health-related Hospital Anxiety and Depression Scale score (odds ratio:
0.79, 95% CI: 0.29–2.12) (QoE: low). Early rehabilitation did not improve
the long-term outcomes of PICS as characterised by EQ5D and SF-36PF.
Conclusions: Early rehabilitation improved only short-term
physical-related outcomes in critically ill patients. Additional large
RCTs are needed.