title: Exercise rehabilitation following intensive care unit discharge for recovery from critical illness: executive summary of a Cochrane Collaboration systematic review.
abstract: Skeletal muscle wasting and weakness are major complications of critical illness and underlie the profound physical and functional impairments experienced by survivors after discharge from the intensive care unit (ICU). Exercise-based rehabilitation has been shown to be beneficial when delivered during ICU admission. This review aimed to determine the effectiveness of exercise rehabilitation initiated after ICU discharge on primary outcomes of functional exercise capacity and health-related quality of life. We sought randomized controlled trials, quasi-randomized controlled trials, and controlled clinical trials comparing an exercise intervention commenced after ICU discharge vs. any other intervention or a control or 'usual care' programme in adult survivors of critical illness. Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature databases were searched up to February 2015. Dual, independent screening of results, data extraction, and quality appraisal were performed. We included six trials involving 483 patients. Overall quality of evidence for both outcomes was very low. All studies evaluated functional exercise capacity, with three reporting positive effects in favour of the intervention. Only two studies evaluated health-related quality of life and neither reported differences between intervention and control groups. Meta-analyses of data were precluded due to variation in study design, types of interventions, and selection and reporting of outcome measurements. We were unable to determine an overall effect on functional exercise capacity or health-related quality of life of interventions initiated after ICU discharge for survivors of critical illness. Findings from ongoing studies are awaited. Future studies need to address methodological aspects of study design and conduct to enhance rigour, quality, and synthesis.
authors.affiliation: Lane Fox Clinical Respiratory Physiology Research Unit Guy's and St Thomas' NHS Foundation TrustLondonUK; Division of Asthma, Allergy, and Lung BiologyKing's College LondonLondonUK; National Institute of Health Research Biomedical Research CentreGuy's and St Thomas' NHS Foundation Trust and King's College LondonLondonUK.
authors.forename: Bronwen
authors.initials: B
authors.lastname: Connolly
authors.affiliation: Edinburgh Critical Care Research Group MRC Centre for Inflammation Research University of Edinburgh Edinburgh UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Salisbury
authors.affiliation: Institute of Nursing and Health Research, School of Health Sciences Ulster University Newtownabbey UK.
authors.forename: Brenda
authors.initials: B
authors.lastname: O'Neill
authors.affiliation: School of Medicine, College of Medicine, Dentistry, and Nursing University of Dundee Dundee UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Geneen
authors.affiliation: National Institute of Health Research Biomedical Research CentreGuy's and St Thomas' NHS Foundation Trust and King's College LondonLondonUK; Department of Public Health Sciences, Division of Health and Social Care ResearchKing's College LondonLondonUK.
authors.forename: Abdel
authors.initials: A
authors.lastname: Douiri
authors.affiliation: Integrative Physiology and Critical Illness Group, Clinical and Experimental SciencesUniversity of SouthamptonSouthamptonUK; Critical Care Research AreaSouthampton NIHR Respiratory Biomedical Research UnitSouthamptonUK; Anaesthesia and Critical Care Research UnitUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK.
authors.forename: Michael P W
authors.initials: MP
authors.lastname: Grocott
authors.affiliation: Lane Fox Clinical Respiratory Physiology Research Unit Guy's and St Thomas' NHS Foundation TrustLondonUK; Division of Asthma, Allergy, and Lung BiologyKing's College LondonLondonUK; National Institute of Health Research Biomedical Research CentreGuy's and St Thomas' NHS Foundation Trust and King's College LondonLondonUK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hart
authors.affiliation: Edinburgh Royal Infirmary Edinburgh UK.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Walsh
authors.affiliation: Health Sciences, School of Medicine, Dentistry, and Biomedical Sciences, Centre for Infection and Immunity Queen's University Belfast Belfast UK.
authors.forename: Bronagh
authors.initials: B
authors.lastname: Blackwood
mesh_terms: D018849:Controlled Clinical Trials as Topic; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000453:epidemiology / Q000401:mortality / Q000534:rehabilitation* / Q000628:therapy; D015444:Exercise; D005081:Exercise Therapy; D006801:Humans; D007362:Intensive Care Units; D010351:Patient Discharge; D063868:Patient Outcome Assessment; D011788:Quality of Life
keywords: Critical illness; Exercise capacity; Exercise rehabilitation; Health‐related quality of life