title: Rehabilitation interventions for postintensive care syndrome: a systematic review.
abstract: OBJECTIVE
  An increasing number of ICU patients survive and develop mental, cognitive, or physical impairments. Various interventions support recovery from this postintensive care syndrome. Physicians in charge of post-ICU patients need to know which interventions are effective.
  
  
  METHODS
  Systematic literature search in databases (MEDLINE, EMBASE, Cochrane CENTRAL, PsycInfo, CINAHL; 1991-2012), reference lists, and hand search.
  
  
  METHODS
  We included comparative studies of rehabilitation interventions in adult post-ICU patients if they considered health-related quality of life, frequency/severity of postintensive care syndrome symptoms, functional recovery, need for care, autonomy in activities of daily living, mortality, or hospital readmissions.
  
  
  METHODS
  Two reviewers extracted data and assessed risk of bias independently.
  
  
  RESULTS
  From 4,761 publications, 18 studies with 2,510 patients were included. Studies addressed 20 outcomes, using 45 measures, covering inpatient (n = 4 trials), outpatient (n = 9), and mixed (n = 5) healthcare settings. Eight controlled trials with moderate to high quality were considered for evaluation of effectiveness. They investigated inpatient geriatric rehabilitation, ICU follow-up clinic, outpatient rehabilitation, disease management, and ICU diaries. Five of these trials assessed posttraumatic stress disorder, with four trials showing positive effects: first, ICU diaries reduced new-onset posttraumatic stress disorder (5% vs 13%, p = 0.02) after 3 months and second showed a lower mean Impact of Event Scale-Revised score (21.0 vs 32.1, p = 0.03) after 12 months. Third, aftercare by ICU follow-up clinic reduced Impact of Event Scale for women (20 vs 31; p < 0.01). Fourth, a self-help manual led to fewer patients scoring high in the Impact of Event Scale after 8 weeks (p = 0.026) but not after 6 months. For none of the other outcomes did more than one study report positive impacts.
  
  
  CONCLUSIONS
  Interventions which have substantial effects in post-ICU patients are rare. Positive effects were seen for ICU-diary interventions for posttraumatic stress disorder. More interventions for the growing number of ICU survivors are needed.
authors.affiliation: 1Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany. 2Paul-Martini-Research Group, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany. 3Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany. 4Medical Directorate, Central Hospital Stuttgart, Stuttgart, Germany. 5Thuringian State and University Library, Jena, Germany. 6Department of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany. 7Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Juliane
authors.initials: J
authors.lastname: Mehlhorn
authors.forename: Antje
authors.initials: A
authors.lastname: Freytag
authors.forename: Konrad
authors.initials: K
authors.lastname: Schmidt
authors.forename: Frank M
authors.initials: FM
authors.lastname: Brunkhorst
authors.forename: Juergen
authors.initials: J
authors.lastname: Graf
authors.forename: Ute
authors.initials: U
authors.lastname: Troitzsch
authors.forename: Peter
authors.initials: P
authors.lastname: Schlattmann
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Jochen
authors.initials: J
authors.lastname: Gensichen
mesh_terms: D000203:Activities of Daily Living; D000359:Aftercare / Q000379:methods / Q000458:organization & administration*; D003422:Critical Care; D016638:Critical Illness / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011788:Quality of Life; D016896:Treatment Outcome