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Early Rehabilitation Program in Critical Patients: Effects on Length of Stay and Mortality. A Literature Review Volume 57- Issue 4

M Messina1*, N Benitez3, S Voltolin2 and GC Tonetti1

  • 1ASST Valle Olona, Rehabilitation Gallarate and Somma Lombardo, Italy
  • 2Insubria University, Italy
  • 3Freelance, Gallarate, Italy

Received: July 12, 2024; Published: July 22, 2024

*Corresponding author: M Messina, ASST Valle Olona, Rehabilitation Gallarate and Somma Lombardo, VA, Italy

DOI: 10.26717/BJSTR.2024.57.009042

Abstract PDF

Background

Immobilisation and prolonged hospitalization predict adverse outcomes in critically ill patients.

Aims

The aim of this review was to assess if early mobilisation and rehabilitation, in Intensive Care unit or Acute care unit, could reduce the length of stay. The secondary outcomes evaluate the efficacy of intra-hospital and 3-months mortality after discharge and the health-related quality of life.

Methods

A literature search in Pub Med, Cochrane, PEDro, Web of Science, and Scopus was performed from March 2021 to March 11, 2023. Preferred Reporting Items for Systematic reviews and Meta- Analyses PRISMA was used. Results were expressed as a risk ratio (RR) with 95% confidence interval. Randomized and non- randomized study designs involving an adult patient population (age range 16-85 years) were included. The “Modified Cochrane Risk of Bias Tool” was used to evaluate the risk of bias in the various studies. Data were extracted from two reviewers, while statistical analysis was performed using Review Manager 5.4.3.

Results

From a total of 115 articles, through the inclusion criteria, 19 studies were selected (Tables 1 & 2). Pooled estimates suggested that early rehabilitation program reduced the length of hospital stay of 2.63 days (fourteen studies, 2183 total patients, 95% CI -2.42 to -1.78, p <0.05) (Graph 1) The same program did not demonstrate statistical significance for in-hospital mortality (seven studies, 872 total patients, relative risk 0.79, 95% CI 0.55 to 1.15 p 0.22) (Graph 2). In contrast, for mortality 3 months after discharge, the efficacy is statistically significant (six articles, 1042 total patients, RR 0.74, 95% CI 0.56 to 0.97 p 0.03) (Graph 3). A high risk of Bias was calculated for the different items and in particular for the blinding of therapists and patients (Table 3) [1-10]. Concerning health related quality of life (hrqol) a qualitative analysis was carried out because of the lack of homogeneity of the data and the diversity of evaluation scales used in the articles. There are five studies evaluating hrqol. Four, as a rating scale, use the SF-36 (Chih-Cheng Lai, Geetha Kayambu, Neil J Greening, Willy Chou) and one uses the EuroQol-5D (Brummel) (Table 4) [11-19].

Table 1:

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Table 2:

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Table 3:

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Table 4:

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Graph 1

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Graph 2

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Graph 3

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Conclusion

Early rehabilitation was effective in reducing the length of stay and mortality 3 months after discharge, although it had no effect on in-hospital mortality and health-related quality of life. Early rehabilitation should be part of good clinical practice in intensive and acute care units.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

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