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      Early versus delayed mobilization for in-hospital mortality and health-related quality of life among critically ill patients: a systematic review and meta-analysis

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          Abstract

          Background

          This systematic review and meta-analysis of randomized clinical trials aimed to investigate the efficacy of early mobilization among critically ill adult patients.

          Methods

          We searched CENTRAL, MEDLINE, and Igaku-Chuo-Zasshi (a Japanese bibliographic database) databases until April 2019 and included randomized control trials to compare early mobilization started within 1 week of intensive care unit (ICU) admission and earlier-than-usual care with the usual care or mobilization initiated later than the intervention. Two authors independently extracted the data of the included studies and assessed their quality. The primary outcomes were in-hospital mortality, length of ICU/hospital stay, and health-related quality of life (QOL).

          Results

          Among 1085 titles/abstracts screened, 11 studies (including 1322 patients) were included in the meta-analysis, which was conducted using the random-effects model. The pooled relative risk for in-hospital mortality comparing early mobilization to usual care (control) was 1.12 (95% CI [confidence interval]: 0.80 to 1.58, I 2 = 0%). The pooled mean differences for duration of ICU and hospital stay were -1.54 (95% CI: -3.33 to 0.25, I 2 = 90%) and -2.86 (95% CI: -5.51 to -0.21, I 2 = 85%), respectively. The pooled mean differences at 6 months post-discharge, as measured by the Short Form 36-Item Health Survey and Euro-QOL EQ-5D, were 4.65 (95% CI: -16.13 to 25.43, I 2 = 86%) for physical functioning and 0.29 (95% CI: -11.19 to 11.78, I 2 = 66%) for the visual analog scale.

          Conclusions

          Our study indicated no apparent differences between early mobilization and usual care in terms of in-hospital mortality and health-related QOL. Detailed larger studies are warranted to evaluate the impact of early mobilization on in-hospital mortality and health-related QOL in critically ill patients.

          Trial registration

          PROSPERO (identifier CRD42019139265)

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          Most cited references10

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          Short form 36 (SF36) health survey questionnaire: normative data for adults of working age.

          C Jenkinson, A. Coulter, L. Wright (1993)
          To gain population norms for the short form 36 health survey questionnaire (SF36) in a large community sample and to explore the questionnaire's internal consistency and validity. Postal survey by using a booklet containing the SF36 and several other items concerned with lifestyles and illness. The sample was drawn from computerised registers of the family health services authorities for Berkshire, Buckinghamshire, Northamptonshire, and Oxfordshire. 13,042 randomly selected subjects aged 18-64 years. Scores for the eight health dimensions of the SF36. The survey achieved a response rate of 72% (n = 9332). Internal consistency of the different dimensions of the questionnaire was high. Normative data broken down by age, sex, and social class were consistent with those from previous studies. The SF36 is a potentially valuable tool in medical research. The normative data provided here may further facilitate its validation and use.
          Article 0 comments Cited 309 times – based on 0 reviews     Review now
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            Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT-ICU) trial.

            Shelley Morandi, Nathan E Brummel, Pratik Pandharipande … (2014)
            Cognitive impairment after critical illness is common and debilitating. We developed a cognitive therapy program for critically ill patients and assessed the feasibility and safety of administering combined cognitive and physical therapy early during a critical illness. We randomized 87 medical and surgical ICU patients with respiratory failure and/or shock in a 1:1:2 manner to three groups: usual care, early once-daily physical therapy, or early once-daily physical therapy plus a novel, progressive, twice-daily cognitive therapy protocol. Cognitive therapy included orientation, memory, attention, and problem-solving exercises, and other activities. We assessed feasibility outcomes of the early cognitive plus physical therapy intervention. At 3 months, we also assessed cognitive, functional, and health-related quality of life outcomes. Data are presented as median (interquartile range) or frequency (%). Early cognitive therapy was a delivered to 41/43 (95%) of cognitive plus physical therapy patients on 100% (92-100%) of study days beginning 1.0 (1.0-1.0) day following enrollment. Physical therapy was received by 17/22 (77%) of usual care patients, by 21/22 (95%) of physical therapy only patients, and 42/43 (98%) of cognitive plus physical therapy patients on 17% (10-26%), 67% (46-87%), and 75% (59-88%) of study days, respectively. Cognitive, functional, and health-related quality of life outcomes did not differ between groups at 3-month follow-up. This pilot study demonstrates that early rehabilitation can be extended beyond physical therapy to include cognitive therapy. Future work to determine optimal patient selection, intensity of treatment, and benefits of cognitive therapy in the critically ill is needed.
            Article 0 comments Cited 86 times – based on 0 reviews     Review now
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              A Binational Multicenter Pilot Feasibility Randomized Controlled Trial of Early Goal-Directed Mobilization in the ICU.

              Carol L Hodgson, Michael Bailey, Rinaldo Bellomo … (2016)
              To determine if the early goal-directed mobilization intervention could be delivered to patients receiving mechanical ventilation with increased maximal levels of activity compared with standard care.
              Article 0 comments Cited 72 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Yohei Okada:
                ORCID: http://orcid.org/0000-0002-2266-476X
                yokada-kyf@umin.ac.jp
                Journal
                Journal ID (nlm-ta): J Intensive Care
                Journal ID (iso-abbrev): J Intensive Care
                Title: Journal of Intensive Care
                Publisher: BioMed Central (London )
                ISSN (Electronic): 2052-0492
                Publication date (Electronic): 9 December 2019
                Publication date PMC-release: 9 December 2019
                Publication date Collection: 2019
                Volume: 7
                Electronic Location Identifier: 57
                Affiliations
                [1 ]ISNI 0000 0004 0372 2033, GRID grid.258799.8, Department of Primary Care and Emergency Medicine, Graduate School of Medicine, , Kyoto University, ; Syogoin Kawaramachi 54, Sakyo, Kyoto, 606-8507 Japan
                [2 ]ISNI 0000 0004 0372 2033, GRID grid.258799.8, Preventive Services, School of Public Health in the Graduate School of Medicine, , Kyoto University, ; Kyoto, Japan
                [3 ]GRID grid.444711.3, School of Nursing, , Sapporo City University, ; Sapporo, Japan
                [4 ]Emergency and Intensive Care Laboratory, Pediatric Intensive Care Unit, University of Tsukuba Hospital, University of Tsukuba, Ibaraki, Japan
                [5 ]ISNI 0000 0000 8733 7415, GRID grid.416704.0, Advanced Emergency and Critical Care Center, , Saitama Red Cross Hospital, ; Saitama, Japan
                [6 ]ISNI 0000 0001 0490 6107, GRID grid.240382.f, The Feinstein Institutes for Medical Research, Department of Emergency Med-Cardiopulmonary, , North Shore University Hospital, Northwell Health System, ; Manhasset, USA
                [7 ]ISNI 0000 0001 1092 3077, GRID grid.31432.37, Department of Disaster and Emergency Medicine, Graduate School of Medicine, , Kobe University, ; Kobe, Japan
                Author information
                http://orcid.org/0000-0002-2266-476X
                Article
                Publisher ID: 413
                DOI: 10.1186/s40560-019-0413-1
                PMC ID: 6902574
                PubMed ID: 31867111
                SO-VID: b6b9fe25-8622-4e18-a1ae-e5f7f9c7acec
                Copyright © © The Author(s). 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 5 September 2019
                Date accepted : 5 November 2019
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                Keywords: early mobilization,rehabilitation,physiotherapy,occupational therapy,critical care
                Data availability:
                Keywords: early mobilization, rehabilitation, physiotherapy, occupational therapy, critical care

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