David E Anekwe1, Sharmistha Biswas2, André Bussières3, Jadranka Spahija4. 1. School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Research Center, CIUSSS du Nord-de-l'Ile-de-Montréal, Sacré-Coeur Hospital, Université de Montréal, Montréal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation in Montreal, CISS du Nord-de-l'Île-de-Montréal, Jewish Rehabilitation Hospital, Laval, Quebec, Canada. 2. Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. 3. School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation in Montreal, CISS du Nord-de-l'Île-de-Montréal, Jewish Rehabilitation Hospital, Laval, Quebec, Canada. 4. School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Research Center, CIUSSS du Nord-de-l'Ile-de-Montréal, Sacré-Coeur Hospital, Université de Montréal, Montréal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation in Montreal, CISS du Nord-de-l'Île-de-Montréal, Jewish Rehabilitation Hospital, Laval, Quebec, Canada. Electronic address: jadranka.spahija@mcgill.ca.
Abstract
BACKGROUND: Intensive care unit-acquired weakness (ICUAW) is associated with significant impairments in body structure and function, activity limitation, and participation restriction. The etiology and management of ICUAW remain uncertain. OBJECTIVE: To estimate the extent to which early rehabilitation interventions (early mobilization [EM] and/or neuromuscular electrical stimulation [NMES]) compared to usual care reduce the incidence of ICUAW in critically ill patients. DATA SOURCES: We searched MEDLINE, EMBASE, CINAHL, Cochrane Central and Physiotherapy Evidence Database databases from inception to May 1st, 2017. ELIGIBILITY CRITERIA: Randomized controlled trials of EM and/or NMES interventions in critically ill adults. DATA EXTRACTION AND DATA SYNTHESIS: Data on the incidence of ICUAW and secondary outcomes were extracted. Both odds and risk ratios for ICUAW were pooled using the random-effects model. RESULTS: We identified 1421 reports after duplicate removal. Nine studies including 841 patients (419 intervention and 422 usual care) were included in the final analysis. The interventions involved EM in five trials, NMES in three trials, and both EM and NMES in one trial. Early rehabilitation decreased the likelihood of developing ICUAW: odds ratio of 0.63 (95% CI: 0.43 to 0.92) in the screened population, and 0.71 (95% CI: 0.53 to 0.95) in the randomized population. CONCLUSION, IMPLICATIONS OF KEY FINDINGS: Early rehabilitation was associated with a decreased likelihood of developing ICUAW. Our findings support early rehabilitation in the ICU. While results were consistent in both the screened and randomized populations, the wide confidence intervals suggest that well-conducted trials are needed to validate our findings. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO registration ID: CRD42017065031.
BACKGROUND: Intensive care unit-acquired weakness (ICUAW) is associated with significant impairments in body structure and function, activity limitation, and participation restriction. The etiology and management of ICUAW remain uncertain. OBJECTIVE: To estimate the extent to which early rehabilitation interventions (early mobilization [EM] and/or neuromuscular electrical stimulation [NMES]) compared to usual care reduce the incidence of ICUAW in critically illpatients. DATA SOURCES: We searched MEDLINE, EMBASE, CINAHL, Cochrane Central and Physiotherapy Evidence Database databases from inception to May 1st, 2017. ELIGIBILITY CRITERIA: Randomized controlled trials of EM and/or NMES interventions in critically ill adults. DATA EXTRACTION AND DATA SYNTHESIS: Data on the incidence of ICUAW and secondary outcomes were extracted. Both odds and risk ratios for ICUAW were pooled using the random-effects model. RESULTS: We identified 1421 reports after duplicate removal. Nine studies including 841 patients (419 intervention and 422 usual care) were included in the final analysis. The interventions involved EM in five trials, NMES in three trials, and both EM and NMES in one trial. Early rehabilitation decreased the likelihood of developing ICUAW: odds ratio of 0.63 (95% CI: 0.43 to 0.92) in the screened population, and 0.71 (95% CI: 0.53 to 0.95) in the randomized population. CONCLUSION, IMPLICATIONS OF KEY FINDINGS: Early rehabilitation was associated with a decreased likelihood of developing ICUAW. Our findings support early rehabilitation in the ICU. While results were consistent in both the screened and randomized populations, the wide confidence intervals suggest that well-conducted trials are needed to validate our findings. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO registration ID: CRD42017065031.
Authors: Julien Cobert; Sun Young Jeon; John Boscardin; Allyson C Chapman; Lauren E Ferrante; Sei Lee; Alexander K Smith Journal: Chest Date: 2022-01-11 Impact factor: 10.262