title: Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The purpose of this systematic review was to review the evidence base for exercise in critically ill patients.
  
  
  METHODS
  Using keywords critical care and physical therapy and related synonyms, randomized controlled trials, meta-analyses, and systematic reviews were identified through electronic database searches and citation tracking. Clinical trials with outcomes of mortality, length of hospital and ICU stay, physical function and quality of life, muscle strength, and ventilator-free days were included.
  
  
  METHODS
  Two reviewers abstracted data and assessed quality independently. Effect sizes and 95% confidence intervals were calculated. From 3,126 screened abstracts, 10 randomized controlled trials and five reviews were found. The mean Physiotherapy Evidence Database score was 5.4. Overall there was a significant positive effect favoring physical therapy for the critically ill to improve the quality of life (g = 0.40, 95% confidence interval 0.08, 0.71), physical function (g = 0.46, 95% confidence interval 0.13, 0.78), peripheral muscle strength (g = 0.27, 95% confidence interval 0.02, 0.52), and respiratory muscle strength (g = 0.51, 95% confidence interval 0.12, 0.89). Length of hospital (g = -0.34, 95% confidence interval -0.53, -0.15) and ICU stay (g = -0.34, 95% confidence interval -0.51, -0.18) significantly decreased and ventilator-free days increased (g = 0.38, 95% confidence interval 0.16, 0.59) following physical therapy in the ICU. There was no effect on mortality.
  
  
  CONCLUSIONS
  Physical therapy in the ICU appears to confer significant benefit in improving quality of life, physical function, peripheral and respiratory muscle strength, increasing ventilator-free days, and decreasing hospital and ICU stay. However, further controlled trials of better quality and larger sample sizes are required to verify the strength of these tentative associations.
authors.affiliation: Burns, Trauma and Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia. g.kayambu@uq.edu.au
authors.forename: Geetha
authors.initials: G
authors.lastname: Kayambu
authors.forename: Robert
authors.initials: R
authors.lastname: Boots
authors.forename: Jennifer
authors.initials: J
authors.lastname: Paratz
mesh_terms: D016638:Critical Illness / Q000534:rehabilitation / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay; D053580:Muscle Strength; D026761:Physical Therapy Specialty / Q000458:organization & administration*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic