School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Research Center, CIUSSS du Nord-de-l'Ile-de-Montréal, Sacré-Coeur Hospital, Université de Montréal, Montréal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation in Montreal, CISS du Nord-de-l'Île-de-Montréal, Jewish Rehabilitation Hospital, Laval, Quebec, Canada.
Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
Physiotherapy. 2020 Jun;107:1-10. doi: 10.1016/j.physio.2019.12.004. Epub 2019 Dec 19.
Intensive care unit-acquired weakness (ICUAW) is associated with significant impairments in body structure and function, activity limitation, and participation restriction. The etiology and management of ICUAW remain uncertain.
To estimate the extent to which early rehabilitation interventions (early mobilization [EM] and/or neuromuscular electrical stimulation [NMES]) compared to usual care reduce the incidence of ICUAW in critically ill patients.
We searched MEDLINE, EMBASE, CINAHL, Cochrane Central and Physiotherapy Evidence Database databases from inception to May 1st, 2017.
Randomized controlled trials of EM and/or NMES interventions in critically ill adults.
Data on the incidence of ICUAW and secondary outcomes were extracted. Both odds and risk ratios for ICUAW were pooled using the random-effects model.
We identified 1421 reports after duplicate removal. Nine studies including 841 patients (419 intervention and 422 usual care) were included in the final analysis. The interventions involved EM in five trials, NMES in three trials, and both EM and NMES in one trial. Early rehabilitation decreased the likelihood of developing ICUAW: odds ratio of 0.63 (95% CI: 0.43 to 0.92) in the screened population, and 0.71 (95% CI: 0.53 to 0.95) in the randomized population.
CONCLUSION, IMPLICATIONS OF KEY FINDINGS: Early rehabilitation was associated with a decreased likelihood of developing ICUAW. Our findings support early rehabilitation in the ICU. While results were consistent in both the screened and randomized populations, the wide confidence intervals suggest that well-conducted trials are needed to validate our findings.
PROSPERO registration ID: CRD42017065031.
重症监护病房获得性肌无力（ICUAW）与身体结构和功能、活动受限以及参与受限有显著关联。其病因和治疗仍存在不确定性。
评估早期康复干预（早期活动[EM]和/或神经肌肉电刺激[NMES]）与常规护理相比，在减少危重症患者 ICUAW 发生率方面的效果。
我们检索了 MEDLINE、EMBASE、CINAHL、Cochrane 中央和物理治疗证据数据库，检索时间截至 2017 年 5 月 1 日。
针对危重症成人的 EM 和/或 NMES 干预的随机对照试验。
提取 ICUAW 发生率和次要结局的数据。ICUAW 的比值比和风险比均采用随机效应模型进行汇总。
在剔除重复项后，我们共识别出 1421 篇报告。最终分析纳入了 9 项研究共 841 例患者（419 例干预组和 422 例常规护理组）。干预措施包括 5 项试验中的 EM、3 项试验中的 NMES，以及 1 项试验中的 EM 和 NMES。早期康复可降低发生 ICUAW 的可能性：在筛选人群中，比值比为 0.63（95%CI：0.43 至 0.92），在随机人群中，比值比为 0.71（95%CI：0.53 至 0.95）。
早期康复与降低 ICUAW 发生的可能性相关。我们的研究结果支持在 ICU 中进行早期康复。尽管筛选人群和随机人群的结果一致，但宽置信区间表明，需要开展精心设计的试验来验证我们的发现。
PROSPERO 注册编号：CRD42017065031。
