Physical rehabilitation interventions for adult patients during critical illness: an overview of systematic reviews
Date
2016-09-13Author
Connolly, Bronwen
O'Neill, Brenda
Salisbury, Lisa
Blackwood, Bronagh
Metadata
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Connolly, B., O''Neill, B., Salisbury, L. & Blackwood, B. (2016) Physical rehabilitation interventions for adult patients during critical illness: an overview of systematic reviews, Thorax, vol. 71, , pp. 881-890,
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. Paper adds to the growing body of evidence that children can acquire phonological systems before they are able to master the phonetic skills needed to convey the contrasts in that system