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

Authors: Wang, Yi Tian; Lang, J; Haines, K; Skinner, E, Haines, T

Position at Peninsula Health: Senior ICU Physiotherapist

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  • What question did you set out to ask in your research?

It has been a number of years since the last systematic review and meta-analysis investigated our main research question – Does physical rehabilitation in ICU improve patient outcomes? There have been a number of trials published since, so we set out to update the literature.

Our second research question was: Are functional exercises (such as sitting out of bed, standing and walking) are more effective than non-functional exercises (bed exercises, electrical muscle stimulation)?

The final research question was: How does the dose of control therapy impact the effectiveness of experimental interventions?  This is because there is considerable variability in the routine physical rehabilitation practices around the world. Some studies compared intense physical rehabilitation (twice a day, seven days per week) to regular physical rehabilitation (once a day, five days per week); other studies compared their experimental intervention to little or no physical rehabilitation. Like most treatments, after a point increasing dosage returns diminishing return. Finding out where that point is has implications on how physical rehabilitation should be resourced in the ICU.

  • How did you go about doing it?

We undertook a systematic review and meta-analysis, and performed sub-group analysis based on characteristics of trials that related to our research questions.

Sub-groups analysis were bases on the 1) type of experimental intervention: functional rehabilitation vs. non-functional rehabilitation and 2) on how much physical rehabilitation were available to the control group: least 5 times per week vs. little or no rehabilitation.

  • What where the interesting findings and what does this mean for clinical practice?

Our main findings were:

Physical rehabilitation begun in the ICU improved patient outcomes.

Functional exercises showed benefits, but nonfunctional exercises did not.

Compared to little or no physical rehabilitation, physical rehabilitation provided benefits. But when compared to a group receiving regular rehabilitation, a higher dosage did not further improve outcomes.

  • Did the findings raise new or unanswered questions?

No, however we did list a number of recommendations for future trials investigating physical rehabilitation in the ICU.

  • What did you enjoy the most when doing this research?

Problem solving, finding novel ways to answer our research questions.

  • Do you have any advice for clinicians wanting to get into research?

Find a good research mentor(s), and seek the support of your manager(s).

  • What’s next for you?
    Try to be a good research mentor to someone else, pay it forward!