Effect of a structured early rehabilitation program on long-term functional recovery, quality of life, and survival in patients with severe acute pancreatitis: a randomized controlled trial.

BACKGROUND

Prolonged immobilization in patients with severe acute pancreatitis (SAP) leads to profound physical deconditioning, yet structured rehabilitation protocols remain underexplored in this population.

OBJECTIVE

To investigate the effects of a structured early rehabilitation nursing (ERN) program on short-term and long-term clinical outcomes, including length of stay, functional recovery, and survival, in patients with severe acute pancreatitis (SAP) admitted to the intensive care unit (ICU).

METHODS

This single-center, prospective, randomized controlled trial was conducted from June 2019 to June 2024. A total of 400 eligible SAP patients admitted to the intensive care unit (ICU) were randomized (1:1) to either the ERN group (n = 200), receiving a protocolized, multidisciplinary rehabilitation program, or the control group (n = 200), receiving usual care. The primary outcome was hospital length of stay (LOS). Key secondary outcomes included ICU LOS, systemic inflammatory markers (CRP, IL-6), muscle strength (MRC sum score), activities of daily living (ADL), quality of life (WHOQOL-BREF), and 1-year all-cause mortality. Assessments were performed at baseline, discharge, and at 3, 6, and 12 months post-discharge.

RESULTS

The ERN group had significantly shorter hospital LOS (11.5 ± 2.5 vs. 14.8 ± 3.1 days, P < 0.001) and ICU LOS (7.2 ± 2.1 vs. 10.5 ± 2.8 days, P < 0.001). At day 7, the ERN group showed lower levels of CRP (48.5 ± 15.2 vs. 95.3 ± 25.4 mg/L, P < 0.001) and IL-6 (55.2 ± 18.3 vs. 110.6 ± 30.1 pg/mL, P < 0.001). At discharge, the ERN group demonstrated superior muscle strength (MRC score: 52.4 ± 4.9 vs. 46.1 ± 5.8, P < 0.001) and functional independence (ADL score: 75.8 ± 8.1 vs. 62.5 ± 9.3, P < 0.001). These functional and quality of life benefits were sustained through the 12-month follow-up. Kaplan-Meier analysis revealed a significantly higher 1-year survival rate in the ERN group (95.0% vs. 87.5%; log-rank P = 0.012). The incidence of ICU-acquired complications was also lower in the ERN group (5.5% vs. 26.0%, P < 0.001).

CONCLUSION

A structured, early rehabilitation nursing program for SAP patients effectively attenuates systemic inflammation, accelerates physical recovery, reduces length of stay, and improves long-term functional outcomes, quality of life, and 1-year survival. These findings support the integration of ERN as a standard of care in the management of critically ill SAP patients.