CAN TELE-REHABILITATION IMPROVE ADULT PATIENTS’ PHYSICAL AND PSYCHOLOGICAL WELL-BEING AFTER DISCHARGE FROM CRITICAL CARE? A SYSTEMATIC REVIEW.

Abstract

1.1 Objectives: To evaluate effectiveness of tele-rehabilitation on physical functioning (exercise capacity, activities of daily living performance) and psychological well-being (anxiety, depression) post-ICU discharge in adult patients with various critical illnesses. 1.2 Search strategies: Searches between February 2018 and April 2018 involved entering key and MeSH terms into MEDLINE, PsycINFO, CINAHL, Open Grey (via EBSCOhost Research Databases). 1.3 Selection criteria: Inclusion criteria involved adults (≥18 years old) admitted to level 3 ICU with critical illnesses and discharged home. Tele-rehabilitation techniques (telephone follow-ups, tele-monitoring, video-conferencing) delivered in a home/community setting, focusing on primary outcomes of physical functioning (exercise capacity, ADL performance) and psychological morbidity (anxiety, depression) were included. Secondary outcome measure involved compliance. Full-text studies of any level of evidence (level 1-5), published in English between 1998 and 2018 were considered. 1.4 Data collection and analysis: The CASP tool was used for methodological assessment and quality of the studies (graded as “low,” “moderate,” “high”). Oxford Centre for Evidence-Based Medicine Levels determined the level of evidence (Level 1: High quality RCT- Level 5: Low quality case series/expert opinion). 1.5 Results: Initial search produced 5512 studies, 8 full-text articles were refined to 4 suitable studies based on inclusion/exclusion criteria. Sample sizes varied from 21-195 participants. Methodological quality across all articles was “moderate.” Mixed results were found regarding the use of tele-rehabilitation to improve exercise capacity, and statistically insignificant results for ADL performance at follow-up. Four studies showed statistically insignificant difference between intervention and control groups in anxiety, and only one showed statistical benefits for depression levels. High compliance was recorded across all studies assessed by self-reports. 1.6 Conclusion: Findings have been inconclusive regarding effectiveness of tele-rehabilitation on physical and psychological morbidities post-ICU discharge in patients with varied critical illnesses. Further research in this field is suggested, including evaluation of tele-rehabilitation as a sole intervention.