Early rehabilitation to prevent post-intensive care syndrome in critical illness patients: a Meta-analysis

Abstract

To systematically evaluate the effects of early exercise on physical function, mental health, quality of life and incidence of post-intensive care syndrome (PICS) in critical illness patients. A computerized search was performed through PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang and VIP Database for randomized controlled trials (RCT) which studied the effects of early exercise in adult patients in intensive care unit (ICU). The retrieval time was from the establishment of database to January 2019. The control group was given routine treatment, while the observation group was given exercise earlier than routine exercise or within 7 days of ICU entry. Two researchers used Cochrane bias risk assessment criteria to evaluate the methodological quality of the included literature and extract data. Meta-analysis was used to analyze the incidence of ICU-AW, Medicine Research Council muscle strength score (MRC-Score), occurrence time of delirium, incidence of anxiety and depression [hospital anxiety and depression scale (HADS)], quality of life [European five-dimensional health scale (EQ5D), concise health survey scale (SF-36) score evaluation] and the incidence of PICS. Nine RCT studies and 917 patients were included. Compared with the control group, the incidence of ICU-AW in the observation group was significantly decreased [odds ratio (OR) = 0.42, 95% confidence interval (95%CI) = 0.22-0.82, P = 0.01], and the MRC-Score was increased [weight mean difference (WMD) = 4.44, 95%CI = 1.18-7.71, P = 0.008]. There was no significant difference in occurrence time of delirium (WMD = -0.05, 95%CI = -0.25-0.15, P = 0.60), and the incidence of anxiety and depression (OR = 0.79, 95%CI = 0.30-2.10, P = 0.64) between the two groups. In quality of life analysis, there was no significant difference in EQ5D score between the two groups (WMD = -5.30, 95%CI = -26.81-16.22, P = 0.63), while SF-36 score in the observation group was significantly higher than that in the control group (WMD = 12.32, 95%CI = 11.38-13.27, P < 0.000 01). Only one study involved the incidence of PICS, so no Meta-analysis was performed. Early exercise can improve the physical function of critical illness patients, but the impact on mental health and quality of life of patients is unclear, and there is no strong evidence for the incidence of PICS.