Effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness: A systematic review and meta-analysis of randomized trials

Abstract

Objective

This systematic review and meta-analysis aimed to analyze the published randomized controlled trials (RCTs) that investigated the effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness.

Design

Systematic review and meta-analysis of RCTs.

Data sources

We searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base, and SciELO (from the earliest date available to January 2023) for RCTs that evaluated the effects of physical rehabilitation interventions following hospital discharge for recovery from critical illness.

Review methods

Study quality was evaluated using the PEDro Scale. Mean differences (MDs), standard MDs (SMD), and 95% confidence intervals (CIs) were calculated.

Results

Fourteen studies met the study criteria, including 1259 patients. Exercise interventions improved aerobic capacity SMD 0.2 (95% CI: 0.03–0.3, I² = 0% N = 880, nine studies, high-quality evidence), and physical component score of health-related quality of life MD 3.3 (95% CI: 1.0–5.6, I² = 57%, six studies N = 669, moderate-quality evidence). In addition, a significant reduction in depression was observed MD −1.4 (95% CI: −2.7 to −0.1, I² = 0% N = 148, three studies, moderate-quality evidence). No serious adverse events were reported.

Conclusion

Exercise intervention was associated with improvement of aerobic capacity, depression, and physical component score of health-related quality of life after hospital discharge for survivors of critical illness.

Keywords

Critical illness exercise rehabilitation systematic review

Background

With the improved survival of critical care patients, the prevalence of impairment and disability among survivors of critical illness has significantly increased.¹ Skeletal muscle wasting and weakness and impaired physical functioning are key disabilities, which impact on a social participation and patient's return to work.² In addition, these muscle impairments are major complications of critical illness and underlie the profound physical and functional disabilities experienced by survivors after discharge.³ Thus, these survivors frequently have substantial morbidity after hospital discharge, including physical, cognitive, and mental health impairments.^2–5 In this context, these patients often require treatments following hospital discharge.

Physical rehabilitation is the cornerstone of management of post critical illness morbidity, and exercise rehabilitation interventions are advocated to target physical and functional disability.^3,4 Physical rehabilitation interventions performed in ICU also aims to primarily ameliorate the effects of muscle weakness and physical function deficits in survivors of critical illness following ICU discharge.⁶ While several studies have examined physical rehabilitation interventions as exercise-based active or passive mobilization delivered to critically ill patients in the ICU,^5,7 some have evaluated the effects of interventions initiated after ICU discharge, and other after hospital discharge.⁸

Recent studies in exercise interventions post ICU discharge and other have investigated it effects performed in ward and are continued after hospital discharge.⁸ Exercise-based active or passive mobilization delivered to critically ill patients has been shown to result in significant improvement in muscle strength, physical function, length ICU stay, and duration of mechanical ventilation.^5,7 Although there are data to support the use of exercise interventions to address physical and functional disabilities within the ICU⁷ and after transfer to the ward^8,9 the clinical benefit beyond hospital discharge is controversial, and therefore, the delivery of such a service has been inconsistent.¹⁰ In addition, there remains limited evidence to support rehabilitation following discharge from hospital for patients who survive critical illness. Moreover, as far as we know, there is no published meta-analysis on the effects of exercise Interventions following hospital discharge for recovery from critical illness.

The aim of this systematic review with meta-analysis was to analyze the published randomized controlled trials (RCTs) that investigated the effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness.

Methods

This systematic review (PROSPERO: CRD42022300724) was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.¹¹

Eligibility criteria

This systematic review included RCTs that studied the effects of exercise Interventions following hospital discharge for recovery from critical illness. According to previous systematic review,¹⁰ we consider critical illness as patients admitted to the ICU, irrespective of causal diagnosis but requiring invasive mechanical ventilation and multiorgan support. For this systematic review, exercise Interventions was defined as exercise and/or passive or active mobility program, use of cycle ergometers involving upper or lower limb pedaling at set levels of intensity, or the application of external adjuncts to enable activation of the muscle in patients unable to actively participate in rehabilitation.¹⁰

Studies were eligible for this systematic review if they met the following criteria: (a) included adult patients (aged ≥18 years) following hospital discharge for recovery from critical illness; (b) a RCT trial design; (c) Exercise Interventions controlled by placebo, no exercise, or other interventions; (d) The outcomes of interest were classified in two health outcomes, namely, functioning (muscle strength, aerobic capacity, balance, mobility, and gait) according to The International Classification of Functioning, Disability and Health, anxiety and depression, and health-related quality of life. Studies with post COVID-19 patients were excluded.

Search methods for identification of studies

We searched for references on MEDLINE/PubMed, EMBASE, PEDro, SciELO, and The Cochrane Central Register of Controlled Trials (CENTRAL) up to January 2023 without language restrictions. We used a standard protocol for this search and, whenever possible, a controlled vocabulary (Mesh term for PubMed and Cochrane, Emtree for EMBASE). In search strategy, we used three groups of keywords and their synonymous: study design, participants, and interventions.

The strategy developed by Higgins and Green¹² was used for the identification of RCTs in PubMed. To identify the RCTs in EMBASE, a search strategy using similar terms was adopted. To identify the RCTs in other database, we adopted a search strategy using similar terms. We checked the references of the articles included in this systematic review to identify other potentially eligible studies. The search strategy for MEDLINE via PubMed, Cochrane library, and EMBASE are presented in Supplemental Material 1.

Data collection and analysis

Titles and abstracts were independently checked by two reviewers. If at least one of the reviewers considered one reference eligible, the full text was obtained for complete assessment. Then, two reviewers independently assessed the full text of selected articles to verify if they met the criteria for inclusion or exclusion. Two authors independently extracted data from the published reports using standard data extraction forms adapted from Higgins and Green.¹²

All studies selected from the databases were exported in an appropriate file. The software EndNote X7.8 (Clarivate, Philadelphia, PA) was used for analysis of eligibility criteria and duplicate analysis. Then, the exported files were also added to the Rayyan Software for evaluation, selection, and data extraction independently by two researchers. Aspects of the study population, intervention performed, follow-up period and rates of missing data, outcome measures, and results were reviewed.

Methodological quality

The quality of RCTs included was scored by two authors using the PEDro scale, which is based on important criteria, such as random allocation, concealed allocation, intention-to-treat analysis, and the point estimates and variability. These characteristics make the PEDro scale a useful tool for assessing the quality of physical rehabilitation RCTs.^13,14 Any disagreements in the rating of the studies were resolved by a third reviewer.

Statistical assessment

Pooled-effect estimates were obtained by comparing the least square mean change from baseline to endpoint for each group and were expressed as the weighted mean difference (MD) between groups. Thus, the [post (-) preintervention] changes in the outcomes were extracted from each study and expressed as mean ± standard deviation (SD). Data were reported as MD, standard MDs (SMD), and 95% confidence interval (CI). For continuous variables, results were expressed as the MD in the change in the variable between randomized groups. Conversion of nonparametric data to means and SD was based on recently established methods.¹⁵ When the SD of change was not available, but CI was available, we converted to SD as guidance by Higgins and Green.¹² If the trial was a multiple-arm RCT, all relevant experimental intervention groups had data extracted. In follow-up reports with multiple end points, only data closest to the end of the physical rehabilitation intervention program were included. Heterogeneity among studies was examined with Cochran's Q and I² statistic, in which values greater than 40% were considered indicative of high heterogeneity.¹⁶ Analyses were performed with Review Manager (Version 5.4).¹⁷

Summary of findings table

The certainty of evidence for the outcomes in meta-analysis was assessed using the GRADE approach.¹² The assessment involved five items: risk of bias, imprecision, inconsistency, indirectness, and publication bias. Decisions to downgrade were justified using footnotes and making comments, where necessary, to aid readers’ understanding of the review.¹²

Results

Description of selected studies

The initial search led to the identification of 3269 abstracts, from which 18 studies were considered as potentially relevant and were retrieved for detailed analysis. Fifteen articles^18–32 met the eligibility criteria. Of these, two articles^18,19 were duplicates (studies that considered the same participants). The study by Turunen et al.¹⁸ used the same participants as the study by Turunen et al.¹⁹ These two articles were considered as a single study. Finally, 14 studies were considered for analysis.^19–32 Supplemental Material 2 shows the PRISMA flow diagram of studies in this review. All studies were scored using the PEDro scale. The results of the assessment of the PEDro scale are presented individually in Supplemental Material 3.

Study characteristics

The number of participants randomized ranged from 20 to 312. The mean 12 studies included patients of both genders, one study³² included only women. Sample size, outcomes, and results of included studies are summarized in Table 1.

Table 1.

Characteristics of included studies.

Authors/year	Sample size (includingdropouts)/Gender	Sample	Age (years)	Outcomes (N)	Dropouts/(intervention and control) (%)	Key findings
Turunen et al., 2020	117/17 (M) 100 (F)	Community-dwelling older recovering from a lower limb or back musculoskeletal injury, surgery, or disorder	79.8	SPPB	8 (6.8%)/I −3 (2.5%) C – 5 (4.3%)	The rehabilitation program was not superior to standard care for increasing physical activity or improving physical performance
Sunde et al, 2020	88/ 45 (M) 43 (F)	Home dwelling older	78.3	6MWT, Gait speed, grip, SF-36, SPPB, BERG	26 (29.5%)/I – 13(14.7%); C – 13 (14.7%)	6-min walk test (0.036), physical component summary of SF-36 (0.001)
Battle et al, 2018	60/31 (M) 29 (F)	Medical and surgical ICU	62	6MWT, grip, BERG, HADS anxiety, HADS depression	26 (43.3%)/I – 15 (25%); C – 11 (18.3%)	Anxiety (P = 0.006) and balance (P = 0.04) were significantly improved in the treatment group at 12 months
McDowell et al, 2017	60/34 (M) 26 (F)	Mechanically ventilated >96 h, and not in other rehabilitation	51	6MWT, hand held dynamometry, SF-36, EQ5D, HADS anxiety, HADS depression	14 (23.3%)/I – 10 (16.6%); C – 4 (6.7%)	SF-36 role physical (P = 0.03); incremental shuttle walk test (P = 0.03); functional limitations profile (P = 0.02); self-efficacy to exercise (P = 0.01), and readiness to exercise (P < 0.001)
McWilliams et al 2017	73/48 (M) 25 (F)	Mechanically ventilated >5 days	57.8	VO2peak, Anaerobic Threshold, SF-36	10 (13.7%)/I – 7(9.6%); C – 3(4.1%)	SF-36 – physical component (0.048) and mental component (P = 0.017)
Vitacca et al, 2016	48/26 (M) 22(F)	Critical care survivors	65.6	MIP/MEP, EQ-5D, BADL	12 (25%)/I – 3 (6.25%); C – 9 (18.7%)	Maximal inspiratory pressure and maximum expiratory pressure measured at the mouth (both P < 0.03), quality of life (Euroquol-5D) (P = 0.04), FEV1 (P = 0.03), dyspnea (P = 0.002), and respiratory rate (P= 0.009)
Connolly et al, 2015	20/ 6 (M) 14 (F)	Mechanically ventilated > 48 h, with ICU-AW diagnosis at ICU discharge	66.5	ISMT, 6MWT, SF-36, HADS anxiety, HADS depression	4 (20%)/I – 0 (0%); C – 4 (20%)	SF-36 – physical component (P = 0.01) and mental component (P = 0.03)
Batterham et al, 2014	59/38 (M) 21 (F)	Minimum of 3 days of ventilator support	41.6	VO2peak, Anaerobic Threshold, SF-36, EQ5D, HADS anxiety, HADS depression	17 (28.8%)/I – 11 (18.6%); C – 6 (10.2%)	There are no statistically significant differences
Sherrington et al, 2014	340/89 (M) 251 (F)	Aged 60 years and over and had been admitted to and subsequently discharged from nine aged care, rehabilitation, and orthopedic wards at four public hospitals	81.2	Gait speed, SF-12 EQ5D, SPPB	25 (7.3%)/I – 12 (3.5%); C – 13 (3.8%)	At 12-months, performance-based mobility had improved significantly more in the intervention group than in the control group (P = 0.004)
Brovold et al 2013	115/45 (M) 70 (F)	Older people admitted to the hospital because of an acute medical event	78	6MWT, TUG, SF-36	26 (22.6%)/I – 12 (10.4%); C – 14 (12.2%)	6-min walk test (P < 0.001)
Brovold et al 2012	108/37 (M) 71 (F)	Participants eligible for the study were patients admitted at the GDH and aged over 60 years	79	6MWT, TUG, SF-36, BERG,	26 (24.1%)/I – 12 (11.2%); C – 14 (12.9%)	SF-36 on the domains vitality (P < 0.01) and bodily pain (P < 0.04)
Jackson et al, 2012	21/11 (M) 10(F)	With either cognitive or functional impairment at hospital discharge	48.1	Time up and go test, tower test, Functional Activities Questionnaire (FAQ)	4 (19%)/I – 4 (19%); C-0 (0%)	Cognitive executive functioning (Tower test) (P < 0.01), FAQ (P < 0.04)
Elliott et al, 2011	183/112 (M) 71 (F)	Length of stay intensive care of at least 48 h and mechanically ventilated for 24 h or more	57.3	6MWT, SF-36	34 (18.6%)/I – 21 (11.5%); C – 13 (7.1%)	There are no statistically significant differences
Timonen et al, 2006	68/0 (M) 68 (F)	Female patients aged 75 years or older, who were admitted for an acute illness and had difficulties in mobility and balance at admission	75	SF-36, (ADL), (IADL) Joensuu classification	11(16.2%)/I – 8 (11.7%); C – 3 (4.5%)	There are no statistically significant differences

Characteristics of intervention programs

The characteristics of the exercise interventions have been reported in most studies (Supplemental Material 4).

Aerobic capacity

Nine studies^{20–23,25–27,29,31} assessed aerobic capacity as outcome. The total number of patients in the exercise group was 394, whereas 399 patients were included in the usual care group. Because of the different instruments used in the measurement of aerobic capacity (6-min walk test, cardiopulmonary exercise testing, and Step Test), a meta-analysis with SMD was used. The meta-analyses showed (Figure 1(a)) a significant difference on aerobic capacity SMD of 0.2 (95% CI: 0.03–0.3, I² = 0% N = 880, nine studies, high-quality evidence, Table 2) for participants in the exercise group compared with usual care group.

Figure 1.

Exercise interventions versus control.

Table 2.

Exercise compared to UC for [hospital discharge].

Patient or population: [Hospital Discharge] Setting: Rehabilitation Intervention: Exercise Comparison: Usual Care (UC)
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect(95% CI)	No of participants(studies)	Certainty of the evidence(GRADE)	Comments
Outcomes	Risk with UC	Risk with Exercise	Relative effect(95% CI)	No of participants(studies)	Certainty of the evidence(GRADE)	Comments
Aerobic Capacity	-	SMD 0.24 higher (0.1 higher to 0.38 higher)	-	793 (10 RCTs)	⨁⨁⨁⨁ High
SF-36 – PCS	The mean SF-36 – PCS was 0	MD 4.04 higher (1.19 higher to 6.9 higher)	-	341 (4 RCTs)	⨁⨁⨁◯ Moderate^a
SF-36 – MCS	The mean SF-36 – MCS was 0	MD 2.25 higher (1.63 lower to 6.14 higher)	-	341 (4 RCTs)	⨁⨁⨁◯ Moderate^a
HAD A	The mean HAD – HAD A was 0	MD 0.7 lower (2.11 lower to 0.71 higher)	-	148 (3 RCTs)	⨁⨁⨁◯ Moderate^b
HAD D	The mean HAD – HAD D was 0	MD 1.37 lower (2.67 lower to 0.07 lower)	-	148 (3 RCTs)	⨁⨁⨁◯ Moderate^b
Balance	The mean balance was 0	MD 0.27 higher (1.56 lower to 2.09 higher)	-	219 (3 RCTs)	⨁⨁⨁◯ Moderate^b
TUG	The mean TUG was 0	MD 0.19 lower (0.51 lower to 0.13 higher)	-	240 (3 RCTs)	⨁⨁⨁◯ Moderate^b

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; MD: mean difference; SMD: standardized mean difference; RCT: randomized controlled trial.

GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

Balance

Three studies^20,21,29 assessed balance as outcome. The total number of patients in the exercise group was 108, whereas 111 patients were included in the usual care group. Balance was assessed through Berg Balance Scale. The meta-analyses showed (Figure 1(b)) a nonsignificant difference on balance MD of 0.3 (95% CI: −1.6 to 2.1, I² = 0% N = 219, three studies, moderate-quality evidence, downgraded for imprecision, Table 2) for participants in the exercise group compared with usual care group.

Mobility

Three studies^28–30 evaluated mobility. Mobility was assessed through Timed Up and Go Test. The total number of patients in the exercise group was 62, whereas 63 patients were included in the usual care group. The meta-analyses showed (Figure 1(c)) a nonsignificant difference on mobility MD of −0.2 (95% CI: −0.5 to 0.1, I² = 0% N = 240, two studies, moderate-quality evidence, downgraded for imprecision, Table 2) for participants in the exercise group compared with usual care group.

Anxiety and depression

Four studies^21,22,25,26 evaluated anxiety and depression. Anxiety and depression were assessed through Hospital Anxiety and Depression Scale.

Anxiety

The total number of patients in the exercise group was 80, whereas 84 patients were included in the usual care group. The meta-analyses showed (Figure 2) a nonsignificant difference on anxiety of −0.7 (95% CI: −2.1 to 0.7, I² = 0% N = 164, four studies, moderate-quality evidence, downgraded for imprecision, Table 2) for participants in the exercise group compared with usual care group.

Figure 2.

Change in anxiety and depression–exercise interventions versus control.

Depression

The total number of patients in the exercise group was 70, whereas 78 patients were included in the usual care group. The meta-analyses showed (Figure 2) a significant difference on depression of −1.4 (95% CI: −2.7 to −0.1, I² = 0% N = 148, three studies, moderate-quality evidence, downgraded for imprecision, Table 2) for participants in the exercise group compared with usual care group.

Health-related quality of life

Six studies^{20,22,23,25,27,31} assessed health-related quality of life. Five studies assessed by Medical Outcome Study Short Form-36 questionnaire, and one study assessed by SF-12 Version 2.²⁷ Results are represented as a physical component score (PCS) and a mental component score (MCS). The total number of patients in the exercise group was 331, whereas 338 patients were included in the usual care group for both components.

Physical Component Score

The meta-analyses showed (Figure 3) a significant difference in PCS of 3.3 (95% CI: 1.0–5.6, I² = 57%, six studies N = 669, moderate-quality evidence, downgraded for consistency of effect, Table 2) for participants in the exercise group compared with usual care group.

Figure 3.

Change in health-related quality of life–exercise interventions versus control.

Mental Component Score

The meta-analyses showed (Figure 3) a nonsignificant difference in MCS of 2.4 (95% CI: −1.3 to 6.1, I² = 47%, six studies N = 669, moderate-quality evidence, downgraded for consistency of effect, Table 2) for participants in the exercise group compared with usual care group.

Discussion

Our systematic review showed that exercise interventions was associated with improvement of aerobic capacity, and PCS of health-related quality of life after hospital discharge for survivors of critical illness. In addition, a significant reduction in depression was observed. Rehabilitation for survivors of critical illness is increasingly recognized as a vital component in the management of post intensive care syndrome. Exercise-based interventions target the physical functional impairment evident in these patients, which persists long after ICU discharge.^8,10

The strength of this systematic review is the comprehensive search developed by a multidisciplinary team and adherence to best practice methodological guidance. Of note, these results of the meta-analyses were based on evidence that can be considered, on average, of high quality (i.e., PEDro score ≥ 6 for all meta-analyzed outcomes). Moreover, the outcomes included considered in our analysis are related to prognosis chronic disease and hospitalized patients. Another novelty of this systematic review is the addition of anxiety, depression, and health-related quality of life as important outcomes.

One of the main consequences of critical illness is skeletal muscle loss and wasting, which is the cause and underlie the profound physical and functional impairments experienced by survivors after discharge from the ICU.³ Physical rehabilitation during ICU stays has been extensively studied, with evidence in favor of its use in clinical practice.¹⁰ However, its effectiveness when started after hospital discharge is little studied and applied in clinical practice. Therefore, this systematic review presents the available evidence regarding the use of exercises interventions applied after hospital discharge. In this way, we identified the studies that tested their efficacy and observed a positive effect on physical dysfunction, suggesting that their use may be a therapeutic option to restore or maximize physical dysfunction in these patients.

McPeake et al.³³ published a study with the aim of understand the impact of a critical care admission on long-term outcomes, compared to other hospitalized patients without a critical care encounter. They found a significant difference in emotional and social outcomes for critical care and noncritical care hospitalized participants. Patients exposed to critical care were more likely to experience mental health issues such as depression and social isolation following discharge from hospital. Further, it has shown that physical, social, and emotional problems are interrelated. Patients exposed to critical care were more likely to experience mental health issues such as depression and social isolation following discharge from hospital. Further, it has shown that physical, social, and emotional problems are interrelated.³³ In this way, our findings also suggest a reduction in depression, which could favor recovery.

Studies have shown significant and long-lasting physical, psychological, and socioeconomic problems in survivors of critical illness, all of which contribute to a reduced health-related quality of life.^23,34 In addition, hospitalization is followed by a frequently irreversible decline in functional status and health-related quality of life.^35–37 Another important aspect to note is that the hospitalization demonstrably exacerbates patients’ emotions and increases feelings of depression and anxiety.³⁷ Our meta-analysis showed additional improvement in the PCS associated with the quality of life. The eligibility of quality of life as the outcome in this systematic review is important because it is an essential component in a rehabilitation program and is an important outcome in studies involving exercise training.

Despite the findings, the result of this systematic review is limited by variance in exercise protocols (variable intensities and different durations of the exercise programs). Moreover, given that this evidence is from moderate-quality evidence, the interpretation should be analyzed with caution. In addition, patients and therapists were not blinded in any of the included studies. Thus, our results should be viewed considering the considerable variation in the exercise program, and of the small number of included studies, although this ultimately reflects the body of evidence about the effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness.

Taking in account the available studies, this systematic review with meta-analysis showed that exercise interventions performed after hospital discharge for survivors of critical illness was associated with improvement of aerobic capacity, depression, and PCS of health-related quality and should be considered as a component of care of survivors of critical illness after hospital discharge.

Clinical messages

Exercise interventions improve aerobic capacity, and physical component score of health-related quality of life of survivors of critical illness.

Exercise interventions should be considered as a component of care after hospital discharge.

Supplemental Material

sj-docx-1-cre-10.1177_02692155241241665 - Supplemental material for Effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness: A systematic review and meta-analysis of randomized trials

Supplemental material, sj-docx-1-cre-10.1177_02692155241241665 for Effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness: A systematic review and meta-analysis of randomized trials by Bianca Bigogno Reis Cazeta, Rodrigo Santos de Queiroz, Tais Silva Nacimento, Beatriz Reis Ferreira, Micheli Bernardone Saquetto, Bruno Prata Martinez, Vitor Oliveira Carvalho and Mansueto Gomes-Neto in Clinical Rehabilitation

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Bianca Bigogno Reis Cazeta

Micheli Bernardone Saquetto

Mansueto Gomes-Neto

Tais Silva Nacimento

Supplemental material

Supplemental material for this article is available online.

References

Iwashyna

Ely

Smith

, et al. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 2010; 304: 1787–1794.

Parry

Knight

Connolly

, et al. Factors influencing physical activity and rehabilitation in survivors of critical illness: a systematic review of quantitative and qualitative studies. Intensive Care Med 2017; 43: 531–542.

Connolly

Salisbury

O'Neill

, et al. Exercise rehabilitation following intensive care unit discharge for recovery from critical illness: executive summary of a Cochrane Collaboration Systematic Review. J Cachexia Sarcopenia Muscle 2016; 7: 520–526.

Gosselink

Bott

Johnson

, et al. Physiotherapy for adult patients with critical illness: recommendations of the European respiratory society and European Society of Intensive Care Medicine Task force on physiotherapy for critically ill patients. Intensive Care Med 2008; 34: 1188–1199.

Hashem

Nallagangula

Nalamalapu

, et al. Patient outcomes after critical illness: a systematic review of qualitative studies following hospital discharge. Crit Care 2016; 20: 345.

Zorowitz

. ICU-acquired weakness: a rehabilitation perspective of diagnosis, treatment, and functional management. Chest 2016; 150: 966–971.

Tipping

Harrold

Holland

, et al. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med 2017; 43: 171–183.

Connolly

Salisbury

O'Neill

, et al. Exercise rehabilitation following intensive care unit discharge for recovery from critical illness. Cochrane Database Syst Rev 2015; 6: CD008632.

Denehy

Skinner

Edbrooke

, et al. Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months of follow-up. Crit Care 2013; 17: R156.

10.

Connolly

O'Neill

Salisbury

. Blackwood B; enhanced recovery after critical illness programme group. Physical rehabilitation interventions for adult patients during critical illness: an overview of systematic reviews. Thorax 2016; 71: 881–890.

11.

Page

McKenzie

Bossuyt

, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg 2021; 88: 105906.

12.

Higgins

JPT

Thomas

Chandler

, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane, 2021. Available from www.training.cochrane.org/handbook.

13.

Olivo

Macedo

Gadotti

, et al. Scales to assess the quality of randomized controlled trials: a systematic review. PhysTher 2008; 88: 156–175.

14.

Maher

Sherrington

Herbert

, et al. Reliability of the PEDro scale for rating of quality randomized controlled trials. Phys Ther 2003; 83: 713–721.

15.

Wan

Wang

Liu

, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014; 14: 135.

16.

Higgins

Thompson

Deeks

, et al. Measuring inconsistency in meta-analyses. Br Med J 2003; 327: 557–560.

17.

Review Manager (RevMan) [Computer program]. Version 5.4, The Cochrane Collaboration, 2020.

18.

Katri Maria

Laura

Erja

, et al. Effects of a home-based rehabilitation program in community-dwelling older people after discharge from hospital: a subgroup analysis of a randomized controlled trial. Clin Rehabil 2021; 35: 1257–1265.

19.

Turunen

Aaltonen-Määttä

Törmäkangas

, et al. Effects of an individually targeted multicomponent counseling and home-based rehabilitation program on physical activity and mobility in community-dwelling older people after discharge from hospital: a randomized controlled trial. Clin Rehabil 2020; 34: 491–503.

20.

Sunde

Hesseberg

Skelton

, et al. Effects of a multicomponent high intensity exercise program on physical function and health-related quality of life in older adults with or at risk of mobility disability after discharge from hospital: a randomised controlled trial. BMC Geriatr 2020; 20: 464.

21.

Battle

James

Temblett

, et al. Supervised exercise rehabilitation in survivors of critical illness: a randomised controlled trial. J Intensive Care Soc 2019; 20: 18–26.

22.

McDowell

O'Neill

Blackwood

, et al. Effectiveness of an exercise programme on physical function in patients discharged from hospital following critical illness: a randomised controlled trial (the REVIVE trial). Thorax 2017; 72: 594–595.

23.

McWilliams

Benington

Atkinson

. Outpatient-based physical rehabilitation for survivors of prolonged critical illness: a randomized controlled trial. Physiother Theory Pract 2016; 32: 179–190.

24.

Vitacca

Barbano

Vanoglio

, et al. Does 6-month home caregiver-supervised physiotherapy improve post-critical care outcomes?: a randomized controlled trial. Am J Phys Med Rehabil 2016; 95: 571–579.

25.

Connolly

Thompson

Douiri

, et al. Exercise-based rehabilitation after hospital discharge for survivors of critical illness with intensive care unit-acquired weakness: a pilot feasibility trial. J Crit Care 2015; 30: 589–598.

26.

Batterham

Bonner

Wright

, et al. Effect of supervised aerobic exercise rehabilitation on physical fitness and quality-of-life in survivors of critical illness: an exploratory minimized controlled trial (PIX study). Br J Anaesth 2014; 113: 130–137.

27.

Sherrington

Lord

Vogler

, et al. A post-hospital home exercise program improved mobility but increased falls in older people: a randomised controlled trial. PLoS ONE 2014; 9: e104412.

28.

Brovold

Skelton

Bergland

. Older adults recently discharged from the hospital: effect of aerobic interval exercise on health-related quality of life, physical fitness, and physical activity. J Am Geriatr Soc 2013; 61: 1580–1585.

29.

Brovold

Skelton

Bergland

. The efficacy of counseling and progressive resistance home-exercises on adherence, health-related quality of life and function after discharge from a geriatric day-hospital. Arch Gerontol Geriatr 2012; 55: 453–459.

30.

Jackson

Ely

Morey

, et al. Cognitive and physical rehabilitation of intensive care unit survivors: results of the RETURN randomized controlled pilot investigation. Crit Care Med 2012; 40: 1088–1097.

31.

Elliott

McKinley

Alison

, et al. Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program. Crit Care 2011; 15: R142.

32.

Timonen

Rantanen

Mäkinen

, et al. Effects of a group-based exercise program on functional abilities in frail older women after hospital discharge. Aging Clin Exp Res 2006; 18: 50–56.

33.

McPeake

Iwashyna

Henderson

, et al. Long term outcomes following critical care hospital admission: a prospective cohort study of UK biobank participants. Lancet Reg Health Eur 2021; 6: 100121.

34.

Herridge

Tansey

Matté

, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011; 364: 1293–1304.

35.

Billett

Campanharo

CRV

Lopes

MCBT

, et al. Functional capacity and quality of life of hospitalized octogenarians. Rev Bras Enferm 2019; 72: 43–48.

36.

Meira

Lavoura

Ferreira

, et al. Impact of hospitalization in the functionality and quality of life of adults and elderlies. Eur Respir J 2015; 46: PA3547.

37.

Alzahrani

. The effect of hospitalization on patients’ emotional and psychological well-being among adult patients: an integrative review. Appl Nurs Res 2021; 61: 151488.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.05 MB