Claire J Tipping1,2, Meg Harrold3,4, Anne Holland2,5, Lorena Romero6, Travis Nisbet7, Carol L Hodgson8,9. 1. Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. 2. Department of Physiotherapy, The Alfred Hospital, Melbourne, VIC, Australia. 3. Curtin University, Perth, WA, Australia. 4. Royal Perth Hospital, Perth, WA, Australia. 5. Latrobe University, Melbourne, VIC, Australia. 6. The Alfred Hospital, Melbourne, VIC, Australia. 7. Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. 8. Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. carol.hodgson@monash.edu. 9. Department of Physiotherapy, The Alfred Hospital, Melbourne, VIC, Australia. carol.hodgson@monash.edu.
Abstract
PURPOSE: Early active mobilisation and rehabilitation in the intensive care unit (ICU) is being used to prevent the long-term functional consequences of critical illness. This review aimed to determine the effect of active mobilisation and rehabilitation in the ICU on mortality, function, mobility, muscle strength, quality of life, days alive and out of hospital to 180 days, ICU and hospital lengths of stay, duration of mechanical ventilation and discharge destination, linking outcomes with the World Health Organization International Classification of Function Framework. METHODS: A PRISMA checklist-guided systematic review and meta-analysis of randomised and controlled clinical trials. RESULTS: Fourteen studies of varying quality including a total of 1753 patients were reviewed. Active mobilisation and rehabilitation had no impact on short- or long-term mortality (p > 0.05). Meta-analysis showed that active mobilisation and rehabilitation led to greater muscle strength (body function) at ICU discharge as measured using the Medical Research Council Sum Score (mean difference 8.62 points, 95% confidence interval (CI) 1.39-15.86), greater probability of walking without assistance (activity limitation) at hospital discharge (odds ratio 2.13, 95% CI 1.19-3.83), and more days alive and out of hospital to day 180 (participation restriction) (mean difference 9.69, 95% CI 1.7-17.66). There were no consistent effects on function, quality of life, ICU or hospital length of stay, duration of mechanical ventilation or discharge destination. CONCLUSION: Active mobilisation and rehabilitation in the ICU has no impact on short- and long-term mortality, but may improve mobility status, muscle strength and days alive and out of hospital to 180 days. REGISTRATION OF PROTOCOL NUMBER: CRD42015029836.
PURPOSE: Early active mobilisation and rehabilitation in the intensive care unit (ICU) is being used to prevent the long-term functional consequences of critical illness. This review aimed to determine the effect of active mobilisation and rehabilitation in the ICU on mortality, function, mobility, muscle strength, quality of life, days alive and out of hospital to 180 days, ICU and hospital lengths of stay, duration of mechanical ventilation and discharge destination, linking outcomes with the World Health Organization International Classification of Function Framework. METHODS: A PRISMA checklist-guided systematic review and meta-analysis of randomised and controlled clinical trials. RESULTS: Fourteen studies of varying quality including a total of 1753 patients were reviewed. Active mobilisation and rehabilitation had no impact on short- or long-term mortality (p > 0.05). Meta-analysis showed that active mobilisation and rehabilitation led to greater muscle strength (body function) at ICU discharge as measured using the Medical Research Council Sum Score (mean difference 8.62 points, 95% confidence interval (CI) 1.39-15.86), greater probability of walking without assistance (activity limitation) at hospital discharge (odds ratio 2.13, 95% CI 1.19-3.83), and more days alive and out of hospital to day 180 (participation restriction) (mean difference 9.69, 95% CI 1.7-17.66). There were no consistent effects on function, quality of life, ICU or hospital length of stay, duration of mechanical ventilation or discharge destination. CONCLUSION: Active mobilisation and rehabilitation in the ICU has no impact on short- and long-term mortality, but may improve mobility status, muscle strength and days alive and out of hospital to 180 days. REGISTRATION OF PROTOCOL NUMBER: CRD42015029836.
Entities:
Keywords:
Critical illness; Early mobility; Intensive care units; Mortality; Rehabilitation
Authors: Sean M Bagshaw; H Thomas Stelfox; Jeffrey A Johnson; Robert C McDermid; Darryl B Rolfson; Ross T Tsuyuki; Quazi Ibrahim; Sumit R Majumdar Journal: Crit Care Med Date: 2015-05 Impact factor: 7.598
Authors: Carol L Hodgson; Michael Bailey; Rinaldo Bellomo; Susan Berney; Heidi Buhr; Linda Denehy; Belinda Gabbe; Megan Harrold; Alisa Higgins; Theodore J Iwashyna; Rebecca Papworth; Rachael Parke; Shane Patman; Jeffrey Presneill; Manoj Saxena; Elizabeth Skinner; Claire Tipping; Paul Young; Steven Webb Journal: Crit Care Med Date: 2016-06 Impact factor: 7.598
Authors: Margaret S Herridge; Catherine M Tansey; Andrea Matté; George Tomlinson; Natalia Diaz-Granados; Andrew Cooper; Cameron B Guest; C David Mazer; Sangeeta Mehta; Thomas E Stewart; Paul Kudlow; Deborah Cook; Arthur S Slutsky; Angela M Cheung Journal: N Engl J Med Date: 2011-04-07 Impact factor: 91.245
Authors: Neil J Greening; Johanna E A Williams; Syed F Hussain; Theresa C Harvey-Dunstan; M John Bankart; Emma J Chaplin; Emma E Vincent; Rudo Chimera; Mike D Morgan; Sally J Singh; Michael C Steiner Journal: BMJ Date: 2014-07-08
Authors: Carmen E Capo-Lugo; Robert L Askew; Kathryn Muldoon; Matthew Maas; Eric Liotta; Shyam Prabhakaran; Andrew Naidech Journal: Arch Phys Med Rehabil Date: 2019-12-23 Impact factor: 3.966
Authors: Samir Jaber; Giacomo Bellani; Lluis Blanch; Alexandre Demoule; Andrés Esteban; Luciano Gattinoni; Claude Guérin; Nicholas Hill; John G Laffey; Salvatore Maurizio Maggiore; Jordi Mancebo; Paul H Mayo; Jarrod M Mosier; Paolo Navalesi; Michael Quintel; Jean Louis Vincent; John J Marini Journal: Intensive Care Med Date: 2017-08-07 Impact factor: 17.440
Authors: Alain Combes; Dan Brodie; Yih-Sharng Chen; Eddy Fan; José P S Henriques; Carol Hodgson; Philipp M Lepper; Pascal Leprince; Kunihiko Maekawa; Thomas Muller; Sebastian Nuding; Dagmar M Ouweneel; Antoine Roch; Matthieu Schmidt; Hiroo Takayama; Alain Vuylsteke; Karl Werdan; Laurent Papazian Journal: Intensive Care Med Date: 2017-05-03 Impact factor: 17.440
Authors: Kathryn E Callahan; Malaz Boustani; Lauren Ferrante; Daniel E Forman; Jerry Gurwitz; Kevin P High; Frances McFarland; Thomas Robinson; Stephanie Studenski; Mia Yang; Kenneth E Schmader Journal: J Am Geriatr Soc Date: 2020-10-16 Impact factor: 5.562
Authors: Prerna Gupta; Jennifer L Martin; Dale M Needham; Sitaram Vangala; Elizabeth Colantuoni; Biren B Kamdar Journal: Heart Lung Date: 2020-02-24 Impact factor: 2.210