Intensive care unit-acquired weakness is associated with significant impairments in body structure and function, activity limitation, and participation restriction. The aim of this review was to estimate the average effect of early rehabilitation interventions compared to usual care on the incidence of intensive care unit-acquired weakness in critically ill patients.
Sensitive searches were performed in five databases (including Medline, Cochrane CENTRAL, and PEDro). Randomised controlled trials of early rehabilitation intervention (early mobilisation and/or neuromuscular electrical stimulation) in critically ill adults who had not already been diagnosed with intensive care unit-acquired weakness that measured muscle strength were included. The primary outcome was the incidence of intensive care unit-acquired weakness. Secondary outcomes included length of time on mechanical ventilation, discharge location, length of stay (both in intensive care and in hospital), and acute mortality (death in intensive care or hospital). Two reviewers independently identified trials for inclusion, extracted data, and assessed trial quality. Discrepancies were resolved through discussion or by arbitration from a third reviewer. The Cochrane risk of bias tool was used to evaluate trial quality. Meta-analysis was used to calculate the odds ratio and 95% confidence interval (CI) for the incidence of intensive care unit-acquired weakness. Four subgroup analyses were performed: (1) < = 7 vs. > 7 day length of stay in intensive care; (2) intervention starting < = 72 hours vs. > 72 hours of admission to intensive care; (3) the type of intervention (early mobilisation vs. neuromuscular electrical stimulation vs. early mobilisation and neuromuscular electrical stimulation); and, (4) time point for assessing intensive care unit-acquired weakness (awakening, 7th day post-awakening, intensive care discharge, hospital discharge).
Nine trials (841 participants) were included in the analyses. Most participants had received mechanical ventilation. The intervention was progressive early mobilisation exercise in five trials, neuromuscular electrical stimulation in three trials, and a combination of early mobilisation and neuromuscular electrical stimulation in one trial. The control group received early mobilisation interventions as part of usual care in six trials.
Early rehabilitation decreased the likelihood of developing intensive care unit-acquired weakness, with an odds ratio of 0.71 (95% CI 0.53 to 0.95, 9 trials). The effect size was larger for > 7 day length of stay in intensive care (odds ratio 0.51, 95% CI 0.32 to 0.81, 7 trials) compared to shorter stays (odds ratio 0.96, 95% CI 0.50 to 1.85, 2 trials), and when intervention commenced in < =72 hours of admission (odds ratio 0.57, 95% CI 0.37 to 0.88, 7 trials) compared to > 72 hours (odds ratio 0.70, 95% CI 0.17 to 2.84, 2 trials). The type of intervention had an impact on the effect size, with an odds ratio of 0.71 (95% CI 0.45 to 1.12, 5 trials) for progressive early mobilisation exercises, 0.26 (95% CI 0.09 to 0.80, 3 trials) for neuromuscular electrical stimulation, and 0.58 (95% CI 0.17 to 1.98, 1 trial) for a combination of early mobilisation and neuromuscular electrical stimulation. The effect size was largest at hospital discharge (odds ratio 0.37, 95% CI 0.15 to 0.94, 3 trials) compared to awakening (odds ratio 0.92, 95% CI 0.05 to 15.68, 2 trials), 7th day post-awakening (odds ratio 1.08, 95% CI 0.46 to 2.55, 1 trial), and intensive care discharge (odds ratio 0.78, 95% CI 0.49 to 1.24, 6 trials).
Early rehabilitation decreased the likelihood of developing intensive care unit-acquired weakness.
Anekwe DE, et al. Early rehabilitation reduces the likelihood of developing intensive care unit-acquired weakness: a systematic review and meta-analysis. Physiotherapy 2020;107:1-10.