Early rehabilitation reduces the likelihood of developing intensive care unit-acquired weakness: a systematic review and meta-analysis.

Abstract

BACKGROUND\nIntensive care unit-acquired weakness (ICUAW) is associated with significant impairments in body structure and function, activity limitation, and participation restriction. The etiology and management of ICUAW remain uncertain.\n\n\nOBJECTIVE\nTo estimate the extent to which early rehabilitation interventions (early mobilization [EM] and/or neuromuscular electrical stimulation [NMES]) compared to usual care reduce the incidence of ICUAW in critically ill patients.\n\n\nDATA SOURCES\nWe searched MEDLINE, EMBASE, CINAHL, Cochrane Central and Physiotherapy Evidence Database databases from inception to May 1st, 2017.\n\n\nELIGIBILITY CRITERIA\nRandomized controlled trials of EM and/or NMES interventions in critically ill adults.\n\n\nDATA EXTRACTION AND DATA SYNTHESIS\nData on the incidence of ICUAW and secondary outcomes were extracted. Both odds and risk ratios for ICUAW were pooled using the random-effects model.\n\n\nRESULTS\nWe identified 1421 reports after duplicate removal. Nine studies including 841 patients (419 intervention and 422 usual care) were included in the final analysis. The interventions involved EM in five trials, NMES in three trials, and both EM and NMES in one trial. Early rehabilitation decreased the likelihood of developing ICUAW: odds ratio of 0.63 (95% CI: 0.43 to 0.92) in the screened population, and 0.71 (95% CI: 0.53 to 0.95) in the randomized population.\n\n\nCONCLUSION, IMPLICATIONS OF KEY FINDINGS\nEarly rehabilitation was associated with a decreased likelihood of developing ICUAW. Our findings support early rehabilitation in the ICU. While results were consistent in both the screened and randomized populations, the wide confidence intervals suggest that well-conducted trials are needed to validate our findings.\n\n\nSYSTEMATIC REVIEW REGISTRATION NUMBER\nPROSPERO registration ID: CRD42017065031.