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.
Edinburgh Critical Care Research Group MRC Centre for Inflammation Research University of Edinburgh Edinburgh UK.
J Cachexia Sarcopenia Muscle. 2016 Dec;7(5):520-526. doi: 10.1002/jcsm.12146. Epub 2016 Sep 16.
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.
骨骼肌减少和无力是危重病的主要并发症，也是导致重症监护病房（ICU）出院后幸存者身体和功能严重受损的主要原因。研究表明，在 ICU 住院期间进行基于运动的康复治疗是有益的。本综述旨在确定 ICU 出院后开始的运动康复对主要功能运动能力和健康相关生活质量结果的有效性。我们检索了比较 ICU 出院后开始的运动干预与任何其他干预、对照组或“常规护理”方案的随机对照试验、准随机对照试验和对照临床试验，纳入了 ICU 危重病幸存者的成年患者。Cochrane 对照试验中心注册库、医学文献分析和检索系统在线（MEDLINE）、医学文摘数据库和护理学及相关健康文献累积索引数据库的检索截止日期为 2015 年 2 月。对结果进行了双重、独立筛选、数据提取和质量评估。我们纳入了 6 项涉及 483 名患者的试验。这两个结果的总体证据质量均为极低。所有研究均评估了功能运动能力，其中 3 项研究的结果均有利于干预组。只有两项研究评估了健康相关生活质量，且均未报告干预组与对照组之间的差异。由于研究设计、干预类型以及结果测量的选择和报告存在差异，因此无法进行数据分析。我们无法确定 ICU 出院后开始的干预措施对危重病幸存者的功能运动能力或健康相关生活质量的总体影响。正在进行的研究的结果正在等待中。未来的研究需要解决研究设计和实施的方法学方面的问题，以提高严谨性、质量和综合水平。
