Exercise rehabilitation following intensive care unit discharge for recovery from critical illness

Background Skeletal muscle wasting and weakness are significant complications of critical illness, associated with degree of illness severity and periods of reduced mobility during mechanical ventilation. They contribute to the profound physical and functional deficits observed in survivors. These impairments may persist for many years following discharge from the intensive care unit (ICU) and can markedly influence health‐related quality of life. Rehabilitation is a key strategy in the recovery of patients after critical illness. Exercise‐based interventions are aimed at targeting this muscle wasting and weakness. Physical rehabilitation delivered during ICU admission has been systematically evaluated and shown to be beneficial. However, its effectiveness when initiated after ICU discharge has yet to be established. Objectives To assess the effectiveness of exercise rehabilitation programmes, initiated after ICU discharge, for functional exercise capacity and health‐related quality of life in adult ICU survivors who have been mechanically ventilated longer than 24 hours. Search methods We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid SP MEDLINE, Ovid SP EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCO host to 15 May 2014. We used a specific search strategy for each database. This included synonyms for ICU and critical illness, exercise training and rehabilitation. We searched the reference lists of included studies and contacted primary authors to obtain further information regarding potentially eligible studies. We also searched major clinical trials registries (Clinical Trials and Current Controlled Trials) and the personal libraries of the review authors. We applied no language or publication restriction. We reran the search in February 2015 and will deal with the three studies of interest when we update the review. Selection criteria We included randomized controlled trials (RCTs), quasi‐RCTs and controlled clinical trials (CCTs) that compared an exercise intervention initiated after ICU discharge versus any other intervention or a control or ‘usual care’ programme in adult (≥ 18 years) survivors of critical illness. Data collection and analysis We used standard methodological procedures as expected by the Cochrane Collaboration. Main results We included six trials (483 adult ICU participants). Exercise‐based interventions were delivered on the ward in two