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Physical Rehab in ICU improves function, reduces length of stay

11/09 - Critically ill patients who start physical rehabilitation while they're in the intensive care unit (ICU) may have better physical outcomes and shorter lengths of stay in the ICU and the hospital, a systematic review and meta-analysis suggests.

Researchers examined data on a total of 5,352 patients from 60 randomized controlled trials and controlled clinical trials that compared the effect of rehabilitation started in the ICU to standard care, which might include rehabilitation started after ICU discharge.

Physical rehabilitation started in the ICU led to significantly better physical function at hospital discharge (standardized mean difference 0.22), although there was no longer a difference at six months, a random-effects pooled analysis found.

In addition, physical rehabilitation initiated in the ICU significantly reduced the length of stay in the ICU (mean difference 0.80 days) and in the hospital overall (mean difference 1.75 days).

"Physical rehabilitation that commences in the ICU improves physical function at hospital discharge and reduces ICU and hospital length of stay," the study team writes in Critical Care Medicine. "However, it does not appear to impact mechanical ventilation duration, muscle strength, health-related quality of life, and mortality."

Compared to standard care without rehabilitation, low-dose physical rehabilitation was associated with a significantly shorter hospital length of stay (mean difference 2.45 days). There was no meaningful difference between high-dose physical rehabilitation and standard care, however.

Functional interventions resulted in a significant reduction in hospital length of stay (mean difference 1.9 days) but non-functional rehabilitation didn't significantly alter length of stay, the study also found.

It's possible that physical rehabilitation resulted in shorter ICU and hospital length of stay because exercise can improve cognition and reduce delirium, the researchers note.

Because sedation optimization is needed for patients to participate in rehabilitation, they may also have a shorter length of stay because of the sedation breaks needed for exercises, the researchers also write. Sedation reduction has previously been linked to reduced use of mechanical ventilation and shorter length of stay in the ICU.

One limitation of the study, the authors note, is that they lacked data to assess the role of sedation in the outcomes.

Another limitation is the considerable heterogeneity in methodology of the studies included in the analysis and in the confidence intervals of the pooled results, the researchers also point out.

However, the results suggest that ICUs should offer physical rehabilitation up to five days a week for patients that are able to do this, the authors conclude.

"In ICUs that already provide physical rehabilitation services at least 5 days per week, a further increase in the dosage of rehabilitation is unlikely to improve outcomes further," the researchers write.

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