Interventions to improve the physical function of ICU survivors: a systematic review.
BACKGROUND
ICU admissions are ever increasing across the United States. Following critical illness, physical functioning (PF) may be impaired for up to 5 years. We performed a systematic review of randomized controlled trials evaluating the efficacy of interventions targeting PF among ICU survivors. The objective of this study was to identify effective interventions that improve long-term PF in ICU survivors.


METHODS
MEDLINE, Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Physiotherapy Evidence-Based Database (PEDro) were searched between 1990 and 2012. Two reviewers independently evaluated studies for eligibility, critically appraised the included studies, and extracted data into standardized evidence tables.


RESULTS
Fourteen studies met the inclusion criteria. Interventions included exercise/physical therapy (PT), parenteral nutrition, nurse-led follow-up, spontaneous awakening trials, absence of sedation during mechanical ventilation, and early tracheotomy. Nine studies failed to demonstrate efficacy on PF of the ICU survivors. However, early physical exercise and PT-based interventions had a positive effect on long-term PF.


CONCLUSIONS
The only effective intervention to improve long-term PF in critically ill patients is exercise/PT; its benefit may be greater if started earlier. Further research in this area comparing different interventions and timing is needed.
Division of Pulmonary, Allergy, Critical Care, Occupational, and Sleep Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
Enrique
E
Calvo-Ayala
Division of Pulmonary, Allergy, Critical Care, Occupational, and Sleep Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN; Regenstrief Institute, Indianapolis, IN. Electronic address: bakhan@iupui.edu.
Babar A
BA
Khan
Division of Pulmonary, Allergy, Critical Care, Occupational, and Sleep Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
Mark O
MO
Farber
Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN; Department of Medicine, and the Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN; Veterans Affairs Tennessee Valley Geriatric Research, Education, and Clinical Center, Nashville, TN.
E Wesley
EW
Ely
Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN; Regenstrief Institute, Indianapolis, IN.
Malaz A
MA
Boustani
D016638:Critical Illness / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D011788:Quality of Life