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The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review

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Abstract

Purpose

Early active mobilisation and rehabilitation in the intensive care unit (ICU) is being used to prevent the long-term functional consequences of critical illness. This review aimed to determine the effect of active mobilisation and rehabilitation in the ICU on mortality, function, mobility, muscle strength, quality of life, days alive and out of hospital to 180 days, ICU and hospital lengths of stay, duration of mechanical ventilation and discharge destination, linking outcomes with the World Health Organization International Classification of Function Framework.

Methods

A PRISMA checklist-guided systematic review and meta-analysis of randomised and controlled clinical trials.

Results

Fourteen studies of varying quality including a total of 1753 patients were reviewed. Active mobilisation and rehabilitation had no impact on short- or long-term mortality (p > 0.05). Meta-analysis showed that active mobilisation and rehabilitation led to greater muscle strength (body function) at ICU discharge as measured using the Medical Research Council Sum Score (mean difference 8.62 points, 95% confidence interval (CI) 1.39–15.86), greater probability of walking without assistance (activity limitation) at hospital discharge (odds ratio 2.13, 95% CI 1.19–3.83), and more days alive and out of hospital to day 180 (participation restriction) (mean difference 9.69, 95% CI 1.7–17.66). There were no consistent effects on function, quality of life, ICU or hospital length of stay, duration of mechanical ventilation or discharge destination.

Conclusion

Active mobilisation and rehabilitation in the ICU has no impact on short- and long-term mortality, but may improve mobility status, muscle strength and days alive and out of hospital to 180 days.

Registration of protocol number

CRD42015029836.

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Acknowledgements

To the authors who supplied clarification of published data and provided unpublished results: Professor Linda Denehy, Dr. Marc Moss, Geetha Kayambu, Dr. Krysta Wolfe and Dr. Nathan Brummel.

Author information

Authors and Affiliations

  1. Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia

    Claire J. Tipping & Carol L. Hodgson

  2. Department of Physiotherapy, The Alfred Hospital, Melbourne, VIC, Australia

    Claire J. Tipping, Anne Holland & Carol L. Hodgson

  3. Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia

    Travis Nisbet

  4. Curtin University, Perth, WA, Australia

    Meg Harrold

  5. Royal Perth Hospital, Perth, WA, Australia

    Meg Harrold

  6. Latrobe University, Melbourne, VIC, Australia

    Anne Holland

  7. The Alfred Hospital, Melbourne, VIC, Australia

    Lorena Romero

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  1. Claire J. Tipping
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Correspondence to Carol L. Hodgson.

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Conflicts of interest

None of the authors have any financial conflicts of interest. Three of the authors (CT, MH and CH) are authors on one of the randomised controlled trials included in the review. The data extraction and risk of bias assessment for this study were completed by two independent researchers.

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Tipping, C.J., Harrold, M., Holland, A. et al. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med 43, 171–183 (2017). https://doi.org/10.1007/s00134-016-4612-0

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  • DOI: https://doi.org/10.1007/s00134-016-4612-0

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