Physical rehabilitation interventions for adult patients during critical illness: an overview of systematic reviews

Bronwen Connolly, Brenda O'Neill, Lisa Salisbury, Bronagh Blackwood, Enhanced Recovery After Critical Illness Programme Group, Bronwen Connolly, Brenda O'Neill, Lisa Salisbury, Bronagh Blackwood, Enhanced Recovery After Critical Illness Programme Group

Abstract

Background: Physical rehabilitation interventions aim to ameliorate the effects of critical illness-associated muscle dysfunction in survivors. We conducted an overview of systematic reviews (SR) evaluating the effect of these interventions across the continuum of recovery.

Methods: Six electronic databases (Cochrane Library, CENTRAL, DARE, Medline, Embase, and Cinahl) were searched. Two review authors independently screened articles for eligibility and conducted data extraction and quality appraisal. Reporting quality was assessed and the Grading of Recommendations Assessment, Development and Evaluation approach applied to summarise overall quality of evidence.

Results: Five eligible SR were included in this overview, of which three included meta-analyses. Reporting quality of the reviews was judged as medium to high. Two reviews reported moderate-to-high quality evidence of the beneficial effects of physical therapy commencing during intensive care unit (ICU) admission in improving critical illness polyneuropathy/myopathy, quality of life, mortality and healthcare utilisation. These interventions included early mobilisation, cycle ergometry and electrical muscle stimulation. Two reviews reported very low to low quality evidence of the beneficial effects of electrical muscle stimulation delivered in the ICU for improving muscle strength, muscle structure and critical illness polyneuropathy/myopathy. One review reported that due to a lack of good quality randomised controlled trials and inconsistency in measuring outcomes, there was insufficient evidence to support beneficial effects from physical rehabilitation delivered post-ICU discharge.

Conclusions: Patients derive short-term benefits from physical rehabilitation delivered during ICU admission. Further robust trials of electrical muscle stimulation in the ICU and rehabilitation delivered following ICU discharge are needed to determine the long-term impact on patient care. This overview provides recommendations for design of future interventional trials and SR.

Trial registration number: CRD42015001068.

Keywords: Exercise.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
Flow diagram summarising systematic review selection. OLS, online supplementary material; RCT, randomised controlled trial.
Figure 2
Figure 2
Summary of PRISMA checklist section items reported across all included reviews. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses.
Figure 3
Figure 3
Summary of completion of AMSTAR items across all included reviews. For full AMSTAR item descriptors, see online supplementary section E5. AMSTAR, Assessment of Multiple Systematic Reviews.

References

    1. Puthucheary ZA, Rawal J, McPhail M, et al. . Acute skeletal muscle wasting in critical illness. JAMA 2013;310:1591–600. 10.1001/jama.2013.278481
    1. Puthucheary ZAP, Phadke RF, Rawal JM, et al. . Qualitative ultrasound in acute critical illness muscle wasting. Crit Care Med 2015;43:1603–11. 10.1097/CCM.0000000000001016
    1. Herridge MS, Tansey CM, Matté A, et al. . Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011;364:1293–304. 10.1056/NEJMoa1011802
    1. Needham D, Dinglas V, Bienvenu OJ, et al. . One year outcomes in patients with acute lung injury randomised to initial trophic or full enteral feeding: prospective follow-up of EDEN randomised trial. BMJ 2013;346:f1532 10.1136/bmj.f1532
    1. Fan E, Dowdy DW, Colantuoni E, et al. . Physical complications in acute lung injury survivors: a two-year longitudinal prospective study. Crit Care Med 2014;42:849–59. 10.1097/CCM.0000000000000040
    1. Connolly B. Describing and measuring recovery and rehabilitation after critical illness. Curr Opin Crit Care 2015;21:445–52. 10.1097/MCC.0000000000000233
    1. NICE. Rehabilitation after critical illness. NICE Clinical Guideline 83. London, UK: National Institute for Health and Care Excellence, 2009; (accessed 1 May 2015).
    1. Hodgson C, Needham D, Haines K, et al. . Feasibility and inter-rater reliability of the ICU Mobility Scale. Heart Lung 2014;43:19–24. 10.1016/j.hrtlng.2013.11.003
    1. Needham DM, Korupolu R, Zanni JM, et al. . Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil 2010;91:536–42. 10.1016/j.apmr.2010.01.002
    1. Gruther W, Kainberger F, Fialka-Moser V, et al. . Effects of neuromuscular electrical stimulation on muscle layer thickness of knee extensor muscles in intensive care unit patients: a pilot study. J Rehabil Med 2010;42:593–7. 10.2340/16501977-0564
    1. Burtin C, Clerckx B, Robbeets C, et al. . Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med 2009;37:2499–505. 10.1097/CCM.0b013e3181a38937
    1. Walsh TS, Salisbury LG, Merriweather JL, et al. . Increased hospital-based physical rehabilitation and information provision after intensive care unit discharge: the RECOVER randomized clinical trial. JAMA Intern Med 2015;175:901–10. 10.1001/jamainternmed.2015.0822
    1. Connolly B, Salisbury L, O'Neill B, et al. . Exercise rehabilitation for recovery from critical illness following intensive care unit discharge. Cochrane Database Syst Rev 2015;(5):CD008632 10.1002/14651858.CD008632.pub2
    1. Higgins J, Green SE. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011.
    1. Moher D, Shamseer L, Clarke M, et al. . Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4:1 10.1186/2046-4053-4-1
    1. Connolly B, O'Neill B, Salisbury L, et al. . Physical rehabilitation interventions for adult patients with critical illness across the continuum of recovery: an overview of systematic reviews protocol. Syst Rev 2015;4:130 10.1186/s13643-015-0119-y
    1. World Health Organisation: International Classification of Functioning, Disability and Health (ICF). (accessed 17 12 2014).
    1. Liberati A, Altman DG, Tetzlaff J, et al. . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700 10.1136/bmj.b2700
    1. Shea B, Grimshaw J, Wells G, et al. . Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 2007;7:10 10.1186/1471-2288-7-10
    1. Guyatt GH, Oxman AD, Vist GE, et al. . GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924–6. 10.1136/
    1. Ferreira LL, Vanderlei LC, Valenti VE. Neuromuscular electrical stimulation in critically ill patients in the intensive care unit: a systematic review. Einstein 2014;12:361–5. 10.1590/S1679-45082014RW2955
    1. Maffiuletti NA, Roig M, Karatzanos E, et al. . Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: a systematic review. BMC Medicine 2013;11:137 10.1186/1741-7015-11-137
    1. Pinheiro A, Christofoletti G. Motor physical therapy in hospitalized patients in an intensive care unit: a systematic review. Rev Bras Ter Intensiva 2012;24:188–96. 10.1590/S0103-507X2012000200016
    1. Calvo-Ayala E, Khan BA, Farber MO, et al. . Interventions to improve the physical function of ICU survivors: a systematic review. Chest 2013;144:1469–80. 10.1378/chest.13-0779
    1. Hermans G, De Jonghe B, Bruyninckx F, et al. . Interventions for preventing critical illness polyneuropathy and critical illness myopathy. Cochrane Database Syst Rev 2014;1:CD006832.
    1. Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med 2013;41:1543–54. 10.1097/CCM.0b013e31827ca637
    1. Wageck B, Nunes GS, Silva FL, et al. . Application and effects of neuromuscular electrical stimulation in critically ill patients: systematic review. Med 2014;38:444–54. 10.1016/j.medin.2013.12.003
    1. Smith V, Devane D, Begley CM, et al. . Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Med Res Methodol 2011;11:15 10.1186/1471-2288-11-15
    1. Moss M, Nordon-Craft A, Malone D, et al. . A Randomized trial of an intensive physical therapy program for acute respiratory failure patients. Am J Respir Crit Care Med 2015. 10.1164/rccm.201505-1039OC
    1. Puthucheary ZA, Denehy L. exercise interventions in critical illness survivors: understanding inclusion and stratification criteria. Am J Respir Crit Care Med 2015;191:1464–7. 10.1164/rccm.201410-1907LE
    1. Parry SM, Berney S, Granger CL, et al. . Electrical muscle stimulation in the intensive care setting: a systematic review. Crit Care Med 2013;41: 2406–18. 10.1097/CCM.0b013e3182923642
    1. Li Z, Peng X, Zhu B, et al. . Active mobilization for mechanically ventilated patients: a systematic review. Arch Phys Med Rehabil 2013;94:551–61. 10.1016/j.apmr.2012.10.023
    1. Adler J, Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulm Phys Ther J 2012;23:5–13.
    1. Cheung A, Weir M, Mayhew A, et al. . Overview of systematic reviews of the effectiveness of reminders in improving healthcare professional behavior. Syst Rev 2012;1:36 10.1186/2046-4053-1-36
    1. Kung J, Chiappelli F, Cajulis OO, et al. . From Systematic Reviews to Clinical Recommendations for Evidence-Based Health Care: Validation of Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) for Grading of Clinical Relevance. Open Dent J 2010;4:84–91. 10.2174/1874210601004020084
    1. Sharif MO, Janjua-Sharif FN, Ali H, et al. . Systematic reviews explained: AMSTAR—how to tell the good from the bad and the ugly. Oral Health Dent Manag 2013;12:9–16.
    1. Connolly B, Thompson A, Douiri A, et al. . Exercise-based rehabilitation after hospital discharge for survivors of critical illness with intensive care unit-acquired weakness: a pilot feasibility trial. J Crit Care 2015;30:589–98. 10.1016/j.jcrc.2015.02.002
    1. Jones C, Eddleston J, McCairn A, et al. . Improving rehabilitation after critical illness through outpatient physiotherapy classes and essential amino acid supplement: a randomized controlled trial. J Crit Care 2015;30:901–7. 10.1016/j.jcrc.2015.05.002
    1. Kho ME, Truong AD, Zanni JM, et al. . Neuromuscular electrical stimulation in mechanically ventilated patients: A randomized, sham-controlled pilot trial with blinded outcome assessment. J Crit Care 2015;30:32–9. 10.1016/j.jcrc.2014.09.014
    1. Kayambu G, Boots R, Paratz J. Early physical rehabilitation in intensive care patients with sepsis syndromes: a pilot randomised controlled trial. Intensive Care Med 2015;41:865–74. 10.1007/s00134-015-3763-8
    1. Reay H, Arulkumaran N, Brett SJ. Priorities for future intensive care research in the UK: results of a James Lind alliance priority setting partnership. J Intensive Care Soc 2014;15:288–96. 10.1177/175114371401500405
    1. Buchter RB, Pieper D. How do authors of Cochrane overviews deal with conflicts of interest relating to their own systematic reviews? In: Filtering the information overload for better decisions. Abstracts of the 23rd Cochrane Colloquium. Vienna, Austria: John Wiley & Sons, 2015.
    1. Brown P, Brunnhuber K, Chalkidou K, et al. . How to formulate research recommendations. BMJ 2006;333:804–6. 10.1136/bmj.38987.492014.94
    1. Hoffmann TC, Glasziou PP, Boutron I, et al. . Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 2014;348:g1687 10.1136/bmj.g1687
    1. Connolly B, Blackwood B, Williamson P, et al. Development of a core outcomes set for trials of rehabilitation following critical illness Core Outcome Measures in Effectiveness Trials Initiative 2013. .
    1. 2008. Developing and evaluating complex interventions: new guidance. Medical Research Council. .

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