Goodwin Victoria A, Allan Louise, Bethel Alison, Cowley Alison, Cross Jane L, Day Jo, Drummond Avril, Hall Abi J, Howard Martin, Morley Naomi, Thompson Coon Jo, Lamb Sarah E
University of Exeter, UK.
University of Exeter, UK.
Physiotherapy. 2021 Jun;111:4-22. doi: 10.1016/j.physio.2021.01.007. Epub 2021 Feb 24.
To establish the evidence for rehabilitation interventions tested in populations of patients admitted to ICU and critical care with severe respiratory illness, and consider whether the evidence is generalizable to patients with COVID-19.
The authors undertook a rapid systematic review. Medline (via OvidSP), CINAHL Complete (via EBSCOhost), Cochrane Library, Cochrane Database of Systematic Reviews and CENTRAL (via Wiley), Epistemonikos (via Epistemonikos.org), PEDro (via pedro.org.au) and OTseeker (via otseeker.com) searched to 7 May 2020. The authors included systematic reviews, RCTs and qualitative studies involving adults with respiratory illness requiring intensive care who received rehabilitation to enhance or restore resulting physical impairments or function. Data were extracted by one author and checked by a second. TIDier was used to guide intervention descriptions. Study quality was assessed using Critical Skills Appraisal Programme (CASP) tools.
Six thousand nine hundred and three titles and abstracts were screened; 24 systematic reviews, 11 RCTs and eight qualitative studies were included. Progressive exercise programmes, early mobilisation and multicomponent interventions delivered in ICU can improve functional independence. Nutritional supplementation in addition to rehabilitation in post-ICU hospital settings may improve performance of activities of daily living. The evidence for rehabilitation after discharge from hospital following an ICU admission is inconclusive. Those receiving rehabilitation valued it, engendering hope and confidence.
Exercise, early mobilisation and multicomponent programmes may improve recovery following ICU admission for severe respiratory illness that could be generalizable to those with COVID-19. Rehabilitation interventions can bring hope and confidence to individuals but there is a need for an individualised approach and the use of behaviour change strategies. Further research is needed in post-ICU settings and with those who have COVID-19. Registration: Open Science Framework https://osf.io/prc2y.
确立针对入住重症监护病房（ICU）且患有严重呼吸道疾病的危重症患者群体所进行的康复干预措施的证据，并考量该证据是否可推广至新冠肺炎患者。
作者进行了一项快速系统评价。检索了截至2020年5月7日的Medline（通过OvidSP）、CINAHL Complete（通过EBSCOhost）、Cochrane图书馆、Cochrane系统评价数据库和CENTRAL（通过Wiley）、Epistemonikos（通过Epistemonikos.org）、PEDro（通过pedro.org.au）以及OTseeker（通过otseeker.com）。作者纳入了涉及因呼吸道疾病需要重症监护且接受康复治疗以改善或恢复由此导致的身体损伤或功能的成年患者的系统评价、随机对照试验（RCT）和定性研究。数据由一位作者提取并由另一位作者核对。使用TIDier来指导干预措施的描述。采用关键技能评估程序（CASP）工具评估研究质量。
筛选了6903篇标题和摘要；纳入了24项系统评价、11项RCT和8项定性研究。在ICU实施的渐进性运动计划、早期活动及多组分干预措施可改善功能独立性。在ICU后医院环境中，除康复治疗外进行营养补充可能会改善日常生活活动能力。ICU入院后出院后康复的证据尚无定论。接受康复治疗的患者重视康复，康复带来了希望和信心。
运动、早期活动及多组分计划可能会改善因严重呼吸道疾病入住ICU后的恢复情况，这可能适用于新冠肺炎患者。康复干预措施可为个体带来希望和信心，但需要采用个性化方法并运用行为改变策略。在ICU后环境以及新冠肺炎患者中还需要进一步研究。注册信息：开放科学框架https://osf.io/prc2y 。
