Shimizu Motohiro, Yoshihiro Shodai, Watanabe Shinichi, Aikawa Gen, Fujinami Yoshihisa, Kawamura Yusuke, Matsuoka Ayaka, Nakanishi Nobuto, Shida Haruka, Sugimoto Kensuke, Taito Shunsuke, Inoue Shigeaki
Department of Intensive Care Medicine, Ryokusen-kai Yonemori Hospital, Kagoshima, JPN.
Department of Pharmacy, Hiroshima University Hospital, Hiroshima, JPN.
Cureus. 2024 Dec 5;16(12):e75184. doi: 10.7759/cureus.75184. eCollection 2024 Dec.
This systematic review and meta-analysis evaluated the effects of enhanced rehabilitation initiated after hospital discharge on the quality of life (QOL) in survivors of critical care. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedure. MEDLINE, CENTRAL, Ichushi, Embase, PEDro, and Cumulated Index to Nursing and Allied Health Literature (CINAHL) databases and the International Clinical Trials Registry Platform and ClinicalTrials.gov (for ongoing or unpublished trials) were searched till January 2024. We identified randomized controlled trials (RCTs) with intensive care unit (ICU) survivors focusing on the effects of enhanced rehabilitation initiated after hospital discharge. Enhanced rehabilitation encompasses protocolized programs offering more intensive, frequent, or longer sessions than standard care. Primary outcomes were physical and mental components of the summary of the standardized QOL scale (SF-36) and adverse events. We calculated pooled-effect estimates for these components, expressing the mean difference (MD) and 95% confidence interval (CI). Risk of bias was evaluated using the Risk of Bias 2 tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Nine RCTs (573 patients) were included. Enhanced rehabilitation resulted in no difference in the physical component-summary score (two studies: n=79, MD=3.03, 95% CI: -1.37 to 7.43, I=0%, low-certainty evidence) and a higher mental component-summary score (two studies: n=79, MD=7.27, 95% CI: 2.08-12.46, I=0%, low-certainty evidence). The evidence on the effect of enhanced rehabilitation on adverse events was very uncertain (nine studies: n=558, risk difference: 0.04, 95% CI: 0.00-0.07, I=65%, very low-certainty evidence). Seven studies reported no adverse event occurrence, one reported a serious event requiring hospitalization in the intervention group, and another reported a minor event in the intervention group with none in controls. Enhanced rehabilitation initiated after hospital discharge may improve the mental component of QOL for survivors in the critical care. Due to the smaller number of studies included, the results need further confirmation.
本系统评价和荟萃分析评估了出院后强化康复对危重症幸存者生活质量（QOL）的影响。该评价遵循系统评价和荟萃分析的首选报告项目（PRISMA）程序。检索了MEDLINE、CENTRAL、Ichushi、Embase、PEDro以及护理与联合健康文献累积索引（CINAHL）数据库，以及国际临床试验注册平台和ClinicalTrials.gov（用于正在进行或未发表的试验），检索截至2024年1月。我们纳入了以重症监护病房（ICU）幸存者为研究对象、关注出院后强化康复效果的随机对照试验（RCT）。强化康复包括比标准护理提供更密集、更频繁或更长疗程的标准化方案。主要结局是标准化生活质量量表（SF-36）总结的身体和心理组成部分以及不良事件。我们计算了这些组成部分的合并效应估计值，以表示平均差（MD）和95%置信区间（CI）。使用偏倚风险2工具评估偏倚风险。使用推荐分级评估、制定和评价（GRADE）方法评估证据的确定性。纳入了9项RCT（573例患者）。强化康复在身体组成部分总结得分方面无差异（两项研究：n=79，MD=3.03，95%CI：-1.37至7.43，I²=0%，低确定性证据），而在心理组成部分总结得分方面更高（两项研究：n=79，MD=7.27，95%CI：2.08至12.46，I²=0%，低确定性证据）。关于强化康复对不良事件影响的证据非常不确定（9项研究：n=558，风险差：0.04，95%CI：0.00至0.07，I²=65%，极低确定性证据）。7项研究报告无不良事件发生，1项报告干预组有1例需要住院治疗的严重事件，另一项报告干预组有1例轻微事件，而对照组无事件发生。出院后开始的强化康复可能会改善危重症幸存者生活质量的心理组成部分。由于纳入的研究数量较少，结果需要进一步证实。
