title: Factors influencing physical activity and rehabilitation in survivors of critical illness: a systematic review of quantitative and qualitative studies.
abstract: OBJECTIVE
  To identify, evaluate and synthesise studies examining the barriers and enablers for survivors of critical illness to participate in physical activity in the ICU and post-ICU settings from the perspective of patients, caregivers and healthcare providers.
  
  
  METHODS
  Systematic review of articles using five electronic databases: MEDLINE, CINAHL, EMBASE, Cochrane Library, Scopus. Quantitative and qualitative studies that were published in English in a peer-reviewed journal and assessed barriers or enablers for survivors of critical illness to perform physical activity were included. Prospero ID: CRD42016035454.
  
  
  RESULTS
  Eighty-nine papers were included. Five major themes and 28 sub-themes were identified, encompassing: (1) patient physical and psychological capability to perform physical activity, including delirium, sedation, illness severity, comorbidities, weakness, anxiety, confidence and motivation; (2) safety influences, including physiological stability and concern for lines, e.g. risk of dislodgement; (3) culture and team influences, including leadership, interprofessional communication, administrative buy-in, clinician expertise and knowledge; (4) motivation and beliefs regarding the benefits/risks; and (5) environmental influences, including funding, access to rehabilitation programs, staffing and equipment.
  
  
  CONCLUSIONS
  The main barriers identified were patient physical and psychological capability to perform physical activity, safety concerns, lack of leadership and ICU culture of mobility, lack of interprofessional communication, expertise and knowledge, and lack of staffing/equipment and funding to provide rehabilitation programs. Barriers and enablers are multidimensional and span diverse factors. The majority of these barriers are modifiable and can be targeted in future clinical practice.
authors.affiliation: Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7 Alan Gilbert Building, Parkville, Melbourne, VIC, 3010, Australia. selina.parry@unimelb.edu.au.
authors.forename: Selina M
authors.initials: SM
authors.lastname: Parry
authors.affiliation: Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, VIC, Australia.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Knight
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust and King's College London National Institute of Health Research Biomedical Research Centre, London, UK.|Centre of Human and Aerospace Physiological Sciences, King's College London, London, UK.|Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Bronwen
authors.initials: B
authors.lastname: Connolly
authors.affiliation: International Centre for Allied Health Evidence (iCAHE) and the Sansom Institute, University of South Australia, Adelaide, SA, Australia.
authors.forename: Claire
authors.initials: C
authors.lastname: Baldwin
authors.affiliation: Centre of Human and Aerospace Physiological Sciences, King's College London, London, UK.|Division of Critical Care, Institute of Sports and Exercise Health, University College Hospitals, London, UK.
authors.forename: Zudin
authors.initials: Z
authors.lastname: Puthucheary
authors.affiliation: Department of Critical Care, University of Kentucky, Lexington, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Morris
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust and King's College London National Institute of Health Research Biomedical Research Centre, London, UK.|Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Mortimore
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust and King's College London National Institute of Health Research Biomedical Research Centre, London, UK.|Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.|Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hart
authors.affiliation: Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7 Alan Gilbert Building, Parkville, Melbourne, VIC, 3010, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Denehy
authors.affiliation: Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7 Alan Gilbert Building, Parkville, Melbourne, VIC, 3010, Australia.|Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, VIC, Australia.|Institute for Breathing and Sleep, Melbourne, VIC, Australia.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Granger
mesh_terms: D016638:Critical Illness / Q000534:rehabilitation*; D015444:Exercise; D005190:Family / Q000523:psychology; D006282:Health Personnel / Q000458:organization & administration* / Q000523:psychology; D006801:Humans; D007362:Intensive Care Units; D009042:Motivation; D036301:Qualitative Research; D012720:Severity of Illness Index; D017741:Survivors
keywords: Behaviour change; Critical care; Physical activity; Physical therapy; Rehabilitation; Review