Early rehabilitation reduces the likelihood of developing intensive care unit-acquired weakness: a systematic review and meta-analysis

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

The systematic review shows that early mobilisation in the ICU is associated with a 37% and 29% reduction in the odds of developing an Intensice Care Unit Acuired Weakness (ICUAW) in screened and randomized populations, respectively. This effect is more pronounced in a subgroup of patients with longer ICU LOS. For this subgroup in particular, the effect is highly relevant not only from a clinical point of view but also from an economic point of view, as early mobilisation significantly reduces the length of stay in the intensive care unit. Patients therefore improve more quickly and cost the entire health system less money. An important point considering the fact that resources in the health care system are becoming increasingly scarce. However, there was inconsistent evidence that early rehabilitation is associated with a shorter length of time spent on mechanical ventilation. But the study also showed that early mobilisation is associated with an increased likelihood of being discharged home. This is evidence that not only short-term effects but also significant long-term effects are associated with the intervention.

An effective method for implementing early mobilisation is in-bed cycling. It allows patients to be mobilised in bed at an early stage.

Further information on early mobilisation in intensive care can be found here:

?? lp.thera-trainer.com/early-mobilization

Anekwe DE, et al. Early rehabilitation reduces the likelihood of developing intensive care unit-acquired weakness: a systematic review and meta-analysis. Physiotherapy. 2020 Jun;107:1-10.?

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