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.
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.
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].
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.
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.
Schaller SJ, Anstey M, Blobner M, Edrich T, Grabitz SD, et al. (2016) Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet 388(10052): 1377-1388.
Dong Z, Yu B, Zhang Q, Pei H, Xing J, et al. (2016) Early rehabilitation therapy is beneficial for patients with prolonged mechanical ventilation after coronary artery bypass surgery: A prospective random study. Int Heart J 57(2): 241-246.