Effect of Early Rehabilitation during Intensive Care Unit Stay on Functional Status: Systematic Review and Meta-Analysis

<div><p>Background and Aim</p><p>Critically ill survivors may have functional impairments even five years after hospital discharge. To date there are four systematic reviews suggesting a beneficial impact for mobilisation in mechanically ventilated and intensive care unit (ICU) patients, however there is limited information about the influence of timing, frequency and duration of sessions. Earlier mobilisation during ICU stay may lead to greater benefits. This study aims to determine the effect of early rehabilitation for functional status in ICU/high-dependency unit (HDU) patients.</p><p>Design</p><p>Systematic review and meta-analysis. MEDLINE, EMBASE, CINALH, PEDro, Cochrane Library, AMED, ISI web of science, Scielo, LILACS and several clinical trial registries were searched for randomised and non-randomised clinical trials of rehabilitation compared to usual care in adult patients admitted to an ICU/HDU. Results were screened by two independent reviewers. Primary outcome was functional status. Secondary outcomes were walking ability, muscle strength, quality of life, and healthcare utilisation. Data extraction and methodological quality assessment using the PEDro scale was performed by primary reviewer and checked by two other reviewers. The authors of relevant studies were contacted to obtain missing data.</p><p>Results</p><p>5733 records were screened. Seven articles were included in the narrative synthesis and six in the meta-analysis. Early rehabilitation had no significant effect on functional status, muscle strength, quality of life, or healthcare utilisation. However, early rehabilitation led to significantly more patients walking without assistance at hospital discharge (risk ratio 1.42; 95% CI 1.17-1.72). There was a non-significant effect favouring intervention for walking distance and incidence of ICU-acquired weakness.</p><p>Conclusions</p><p>Early rehabilitation during ICU stay was not associated with improvements in functional status, muscle strength, quality of life or healthcare utilisation outcomes, although it seems to improve walking ability compared to usual care. Results from ongoing studies may provide more data on the potential benefits of early rehabilitation in critically ill patients.</p></div

Forest plot for ICU-acquired weakness.

<p>Forest plot for ICU-acquired weakness.</p

PRISMA flow diagram.

<p>PRISMA flow diagram.</p

Summary of results for the outcome quality of life.

<p>* Values are norm-based t-scores where population mean is 50 and standard deviation is 10.</p><p>Summary of results for the outcome quality of life.</p

Summary of results for the outcome muscle strength.

<p>Summary of results for the outcome muscle strength.</p

Quality assessment based on PEDro scale of clinical trials included in the systematic review.

<p>Quality assessment based on PEDro scale of clinical trials included in the systematic review.</p

Summary of results for the outcome ICU acquired weakness.

<p>Summary of results for the outcome ICU acquired weakness.</p

Additional file 1: of Fluid strategies and outcomes in patients with acute respiratory distress syndrome, systemic inflammatory response syndrome and sepsis: a protocol for a systematic review and meta-analysis

Medline search strategy. Modified versions of this strategy will be used for other databases

Additional file 6: of Barriers and facilitators to early rehabilitation in mechanically ventilated patients—a theory-driven interview study

Frequency of all Beliefs by Profession. (DOCX 29 kb

Targeted populations acceptability and perception of Motivational interviewing : A scoping review of MI from a cultural relativism and universalist perspective

Studien syftar till att undersöka olika målgruppers mottaglighet och uppfattning av Motiverande samtal (MI) utifrån ett universalistiskt och kulturrelativistiskt perspektiv. Bakgrunden är att MI är en frekvent använd samtalsmetod som används i det lösningsfokuserade sociala arbetet samt att en forskningslucka identifierats kring hur MI faktiskt tas emot och uppfattas av olika målgrupper. Studien avser analysera MI utfört i olika kontexter och utifrån både kulturrelativism och universalism. För att undersöka detta har en scoping review gjorts där 35 akademiska artiklar inom forskningsområdet valdes ut och sedan analyserades tematiskt. De fem teman som identifierats är mottaglighet och uppfattning av MI bland olika målgrupper, betydelsen av handledning och utbildning för olika målgruppers inställning till MI, MI:s påverkan för relationsbyggande och dess betydelse för mottagligheten och uppfattningen hos olika målgrupper, potentialen MI har i kombination med andra insatser för olika målgruppers mottaglighet och uppfattning, samt ökad mottaglighet och förbättrad uppfattning genom målgruppsanpassning av MI. Det huvudsakliga resultatet har varit att ett antal aspekter utifrån dessa teman bör beaktas och kan förstås bättre utifrån de två nämnda teoretiska perspektiven. Övergripande förefaller MI mottas och uppfattas väl av olika målgrupper, men flera studier tyder ändå på att resultatet av MI interventioner inte får en långvarig påverkan. The study aims to investigate the receptivity and perception of different target populations of Motivational Interviewing (MI) from a universalist and cultural relativistic perspective. The background is that MI is a frequently used conversational method used in the solution-focused social work and that a research gap has been identified around how MI is received by different target groups. The study intends to analyse MI performed in different contexts and based on both cultural relativism and universalism. To investigate this, a scoping review has been made where 35 academic articles in the research area were selected and then analysed thematically. The five themes identified are receptivity and perception of MI among different target populations, the importance of guidance and education for different target populations attitude to MI, MI's impact on relationship building and its significance for receptivity and perception in different target populations, the potential MI has in combination with other initiatives for the receptivity and perception of different target populations, as well as increased receptivity and improved perception through target populations adaptation of MI. The main result has been that several aspects based on these themes should be considered and can be better understood from the two mentioned theoretical perspectives. Overall, MI seems to be received and perceived well by different target populations, but several studies still indicate that the results of MI interventions do not have a long-term impact