Preventing ICU-Acquired Weakness With Early Rehabilitation: An Umbrella Review of Systematic Reviews and Meta-Analysis.

BACKGROUND

Intensive care unit-acquired weakness (ICU-AW) causes prolonged hospitalisations and higher mortality. Systematic reviews and meta-analyses (SR/MA) regarding ICU-AW and early rehabilitation need a synthesis of the existing evidence.

AIM: The aim of this study was to summarise findings from several SR/MA to provide an overview of early rehabilitation as a means to prevent ICU-AW.

STUDY

DESIGN

This was an umbrella review of SR/MA. Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Joanna Briggs Institute guidelines were used for the process. MEDLINE, Embase, Cochrane Database of Systematic Reviews and Airiti Library were searched for keywords. A search was conducted for papers published from the inception of the databases up to January 2025. Neither language nor publication year was restricted. A meta-analyses would be conducted if there were inconsistencies in the current SR/MA.

RESULTS

An analysis of seven SRs with a quality above medium was conducted. Sixty-nine primary studies from seven SRs discussed early rehabilitation in preventing ICU-AW. According to meta-analyses, early rehabilitation can significantly reduce the incidence of ICU-AW, with a risk difference of -0.10 (95% CI: -0.18 to -0.03, z = 2.580, p = 0.010). Subgroup analysis further revealed that initiating rehabilitation within 1-3 days of ICU admission was associated with a 13% lower risk of ICU-AW (RD: -0.13; 95% CI: -0.22 to -0.04; z = 2.92; p = 0.003). Other subgroup analyses showed no statistically significant differences. The type of early rehabilitation that was most effective could not be determined due to the variability in interventions and outcomes.

CONCLUSIONS

Early rehabilitation could significantly prevent ICU-AW incidence. The meta-analysis indicated that the early rehabilitation group has a 10% lower ICU-AW incidence risk.

RELEVANCE TO CLINICAL PRACTICE: Providing early rehabilitation should be a nursing priority in the ICU in order to prevent ICU-AW and enhance patient recovery.