Exercise rehabilitation following intensive care unit discharge for recovery from critical illness: executive summary of a Cochrane Collaboration systematic review

Bronwen Connolly, Lisa Salisbury, Brenda O'Neill, Louise Geneen, Abdel Douiri, Michael P W Grocott, Nicholas Hart, Timothy S Walsh, Bronagh Blackwood, Bronwen Connolly, Lisa Salisbury, Brenda O'Neill, Louise Geneen, Abdel Douiri, Michael P W Grocott, Nicholas Hart, Timothy S Walsh, Bronagh Blackwood

Abstract

Skeletal muscle wasting and weakness are major complications of critical illness and underlie the profound physical and functional impairments experienced by survivors after discharge from the intensive care unit (ICU). Exercise-based rehabilitation has been shown to be beneficial when delivered during ICU admission. This review aimed to determine the effectiveness of exercise rehabilitation initiated after ICU discharge on primary outcomes of functional exercise capacity and health-related quality of life. We sought randomized controlled trials, quasi-randomized controlled trials, and controlled clinical trials comparing an exercise intervention commenced after ICU discharge vs. any other intervention or a control or 'usual care' programme in adult survivors of critical illness. Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature databases were searched up to February 2015. Dual, independent screening of results, data extraction, and quality appraisal were performed. We included six trials involving 483 patients. Overall quality of evidence for both outcomes was very low. All studies evaluated functional exercise capacity, with three reporting positive effects in favour of the intervention. Only two studies evaluated health-related quality of life and neither reported differences between intervention and control groups. Meta-analyses of data were precluded due to variation in study design, types of interventions, and selection and reporting of outcome measurements. We were unable to determine an overall effect on functional exercise capacity or health-related quality of life of interventions initiated after ICU discharge for survivors of critical illness. Findings from ongoing studies are awaited. Future studies need to address methodological aspects of study design and conduct to enhance rigour, quality, and synthesis.

Keywords: Critical illness; Exercise capacity; Exercise rehabilitation; Health‐related quality of life.

Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Cochrane Risk of Bias summary.

References

    1. Cheung A, Tansey C, Tomlinson G, Diaz‐Granados N, Matte A, Barr A, et al. Two‐year outcomes, health care use, and costs of survivors of acute respiratory distress syndrome. Am J Resp Crit Care Med 2006;174:538–544.
    1. Herridge MS, Cheung AM, Tansey CM. One‐year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 2003;348:.
    1. Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz‐Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011;364:1293–1304.
    1. Needham DM, Dinglas VD, Morris PE, Jackson JC, Hough CL, Mendez‐Tellez PA, et al. Physical and cognitive performance of patients with acute lung injury 1 year after initial trophic versus full enteral feeding. EDEN trial follow‐up. Am J Respir Crit Care Med 2013;188:567–576.
    1. Hopkins RO, Suchyta MR, Farrer TJ, Needham D. Improving post‐intensive care unit neuropsychiatric outcomes. Am J Respir Crit Care Med 2012;186:1220–1228.
    1. Hopkins RO, Weaver LK, Collingridge D, Parkinson RB, Chan KJ, Orme JF Jr. Two‐year cognitive, emotional, and quality‐of‐life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med 2005;171:340–347.
    1. Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, et al. Long‐term cognitive impairment after critical illness. N Engl J Med 2013;369:1306–1316.
    1. Sukantarat K, Greer S, Brett S, Williamson R. Physical and psychological sequelae of critical illness. Br J Health Psychol 2007;12:65–74.
    1. Wade D, Howell D, Weinman J, Hardy R, Mythen M, Brewin C, et al. Investigating risk factors for psychological morbidity three months after intensive care: a prospective cohort study. Crit Care 2012;16:R192.
    1. Cuthbertson B, Roughton S, Jenkinson D, MacLennan G, Vale L. Quality of life in the five years after intensive care: a cohort study. Crit Care 2010;14:R6.
    1. Oeyen SG, Vandijck DM, Benoit DD, Annemans L, Decruyenaere JM. Quality of life after intensive care: a systematic review of the literature. Crit Care Med 2010;38:2386–2400.
    1. Griffiths J, Hatch R, Bishop J, Morgan K, Jenkinson C, Cuthbertson B, et al. An exploration of social and economic outcome and associated health‐related quality of life after critical illness in general intensive care unit survivors: a 12‐month follow‐up study. Crit Care 2013;17:R100.
    1. Unroe M, Kahn JM, Carson SS, Govert JA, Martinu T, Sathy SJ, et al. One‐year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med 2010;153:167–175.
    1. Davidson J, Jones C, Bienvenu OJ. Family response to critical illness: postintensive care syndrome‐family. Crit Care Med 2012;40:618–624.
    1. de Miranda S, Pochard F, Chaize M, Megarbane B, Cuvelier A, Bele N, et al. Postintensive care unit psychological burden in patients with chronic obstructive pulmonary disease and informal caregivers: a multicenter study. Crit Care Med 2011;39:112–118.
    1. Kentish‐Barnes N, Lemiale V, Chaize M, Pochard F, Azoulay E. Assessing burden in families of critical care patients. Crit Care Med 2009;37:S448–S456.
    1. Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long‐term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med 2012;40:502–509.
    1. Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, et al. Acute skeletal muscle wasting in critical illness. JAMA 2013;310:1591–1600.
    1. Connolly B, MacBean V, Crowley C, Lunt A, Moxham J, Rafferty GF, et al. Ultrasound for the assessment of peripheral skeletal muscle architecture in critical illness: a systematic review. Crit Care Med 2014;43:897–905.
    1. Babc C. Describing and measuring recovery and rehabilitation after critical illness. Curr Opin Crit Care 2015;21:445–452.
    1. NICE: Rehabilitation after critical illness. NICE Clinical Guideline 83 National Institute for Health and Care Excellence, London, UK 2009, available at .
    1. Parry S, Berney S, Granger C, Koopman R, El‐Ansary D, Denehy L. Electrical muscle stimulation in the intensive care setting: a systematic review. Crit Care Med 2013;41:2406–2418.
    1. Kho ME, Martin RA, Toonstra AL, Zanni JM, Mantheiy EC, Nelliot A, et al. Feasibility and safety of in‐bed cycling for physical rehabilitation in the intensive care unit. J Crit Care 2015;30:1419.e1411–1419.e1415.
    1. Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med 2007;35:139–145.
    1. Berney S, Haines K, Skinner EH, Denehy L. Safety and feasibility of an exercise prescription approach to rehabilitation across the continuum of care for survivors of critical illness. Phys Ther 2012;92:1524–1535.
    1. Bourdin G, Barbier J, Burle JF, Durante G, Passant S, Vincent B, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one‐center study. Respir Care 2010;55:400–407.
    1. Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med 2010;38:2089–2094.
    1. Sricharoenchai T, Parker A, Zanni J, Nelliot A, Dinglas V, Needham D. Safety of physical therapy interventions in critically ill patients: a single‐center prospective evaluation of 1110 intensive care unit admissions. J Crit Care 2014;29:395–400.
    1. Calvo‐Ayala E, Khan BA, Farber MO, Ely EW, Boustani MA. Interventions to improve the physical function of ICU survivors: a systematic review. Chest 2013;144:1469–1480.
    1. Connolly B, O'Neill B, Salisbury L, Blackwood B: Physical rehabilitation interventions for adult patients during critical illness: an overview of systematic reviews. Thorax 2016, Published Ahead of Print.
    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;41:1543–1554.
    1. Li Z, Peng X, Zhu B, Zhang Y, Xi X. Active mobilization for mechanically ventilated patients: a systematic review. Arch Phys Med Rehabil 2013;94:551–561.
    1. Connolly B, Salisbury L, O'Neill B, Geneen L, Douiri A, Grocott M, et al Exercise rehabilitation following intensive care unit discharge for recovery from critical illness. Cochrane Database Syst Rev 2015. doi: .
    1. Higgins J, Green S, edsEditors. Chapter 8: Assessing risk of bias in included studies In Cochrane Handbook for Systematic Reviews of Interventions wwwcochrane‐handbookorg The Cochrane Collaboration Version 510; 2011.
    1. Batterham AM, Bonner S, Wright J, Howell SJ, Hugill K, Danjoux G. Effect of supervised aerobic exercise rehabilitation on physical fitness and quality‐of‐life in survivors of critical illness: an exploratory minimized controlled trial (PIX study). Br J Anaesth 2014;113:130–137.
    1. Elliott D, McKinley S, Alison J, Aitken L, King M, Leslie G, et al. Health‐related quality of life and physical recovery after a critical illness: a multi‐centre randomised controlled trial of a home‐based physical rehabilitation program. Crit Care 2011;15:R142.
    1. Jackson J, Ely EW, Morey M, Anderson V, Denne L, Clune J, et al. Cognitive and physical rehabilitation of intensive care unit survivors: results of the RETURN randomized controlled pilot investigation. Crit Care Med 2012;40:1088–1097.
    1. Jones C, Skirrow P, Griffiths R, Humphris G, Ingleby S, Eddleston J, et al. Rehabilitation after critical illness: a randomized, controlled trial. Crit Care Med 2003;31:2456–2461.
    1. Porta R, Vitacca M, Gilè LS, Clini E, Bianchi L, Zanotti E, et al. Supported arm training in patients recently weaned from mechanical ventilation. Chest 2005;128:2511–2520.
    1. Salisbury L, Merriweather J, Walsh T. The development and feasibility of a ward‐based physiotherapy and nutritional rehabilitation package for people experiencing critical illness. Clin Rehabil 2010;24:489–500.
    1. Battle C, James K, Temblett P, Hutchings H. Early results of a 6‐week exercise programme in post‐ICU patients. Crit Care 2013;17:P541.
    1. McWilliams D, Benington S, Atkinson J. Outpatient‐based physical rehabilitation for survivors of prolonged critical illness ‐ a randomised controlled trial. J of the Intensive Care Society 2013;14:S‐9.
    1. O'Neill B, McDowell K, Bradley J, Blackwood B, Mullan B, Lavery G, et al. Effectiveness of a programme of exercise on physical function in survivors of critical illness following discharge from the ICU: study protocol for a randomised controlled trial (REVIVE). Trials [Electronic Resource] 2014;15:146.
    1. Walsh TS, Salisbury LG, Merriweather JL, Boyd JA, Griffith DM, Huby G, et al. Increased hospital‐based physical rehabilitation and information provision after intensive care unit discharge: the recover randomized clinical trial. JAMA Intern Med 2015;175:901–910.
    1. Connolly B, Thompson A, Douiri A, Moxham J, Hart N. 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;30:589–598.
    1. Jones C, Eddleston J, McCairn A, Dowling S, McWilliams D, Coughlan E, et al. Improving rehabilitation after critical illness through outpatient physiotherapy classes and essential amino acid supplement: a randomized controlled trial. J Crit Care 2015;30:901–907.
    1. von Haehling S, Morley JE, Coats AJS, Anker SD. Ethical guidelines for publishing in the Journal of Cachexia, Sarcopenia and Muscle: update 2015. J Cachexia Sarcopenia Muscle 2015;6:315–316.

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