Early active mobilization versus active usual care in critically ill subjects: a systematic review and meta-analysis
Abstract
Objective: To evaluate the effect of early active mobilization (EAM) compared to active usual care (AUC) in critically ill adult subjects regarding muscle strength and functional status.
Materials and methods: A systematic review and meta-analysis were conducted. Randomized clinical trials comparing EAM with AUC in subjects >18 years, of both sexes, in critical condition during or after the period of mechanical ventilation in the intensive care unit (ICU) were included. The search was performed in the Cochrane, Medline/Pubmed, Embase (Elsevier), SciELO, LILACS/BVS, www.controlled-trials.com/, clinicaltrials.gov/, and www.who.int/ictrp/en/ databases. Bias risk was assessed using the RoB 1 tool. A qualitative and quantitative synthesis (meta-analysis) of the results was generated. Registration: OSF: https://bit.ly/430fF72.
Results: Seven studies were included in this review, comprising a total of 1905 subjects. The majority of subjects were male (57 %) and aged between 54 and 66 years. The reported outcomes showed low certainty of evidence, according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system . In the meta-analysis of functional status at hospital discharge, a favorable effect was observed in the EAM group, with a standardized mean difference of 0.26 (95 % CI 0.11-0.41) and low heterogeneity (I2 = 0 %).
Conclusion: With low certainty of evidence, the effect of EAM on critically ill adult subjects in the ICU may improve functional status at hospital discharge compared to AUC.
References
Zhou W, Yu L, Fan Y, Shi B, Wang X, Chen T, Yu H, Liu J, Wang X, Liu C, Zheng H. Effect of early mobilization combined with early nutrition on acquired weakness in critically ill patients (EMAS): A dual-center, randomized controlled trial. PLoS One. 2022 May 26;17(5):e0268599. doi: 10.1371/journal.pone.0268599
Crossref
| Google Scholar
Ballve LP, Dargains N, Urrutia Inchaustegui JG, Bratos A, Milagros Percaz M, Bueno Ardariz C, et al. Weakness acquired in the intensive care unit. Incidence, risk factors and their association with inspiratory weakness. Observational cohort study. Rev Bras Ter Intensiva. 2017 Oct-Dec;29(4):466-475. doi: 10.5935/0103-507X.20170063
Crossref
| Google Scholar
Appleton RT, Kinsella J, Quasim T. The incidence of intensive care unit-acquired weakness syndromes: A systematic review. J Intensive Care Soc. 2015 May;16(2):126-136. doi: 10.1177/1751143714563016
Crossref
| Google Scholar
Dres M, Dubé BP, Mayaux J, Delemazure J, Reuter D, Brochard L, et al. Coexistence and Impact of Limb Muscle and Diaphragm Weakness at Time of Liberation from Mechanical Ventilation in Medical Intensive Care Unit Patients. Am J Respir Crit Care Med. 2017 Jan 1;195(1):57-66. doi: 10.1164/rccm.201602-0367OC
Crossref
| Google Scholar
Garnacho-Montero J, Amaya-Villar R, García-Garmendía JL, Madrazo-Osuna J, Ortiz-Leyba C. Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Crit Care Med. 2005 Feb;33(2):349-54. doi: 10.1097/01.CCM.0000153521.41848.7E
Crossref
| Google Scholar
Hermans G, Van Mechelen H, Clerckx B, Vanhullebusch T, Mesotten D, Wilmer A, et al. Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. A cohort study and propensity-matched analysis. Am J Respir Crit Care Med. 2014 Aug 15;190(4):410-20. doi: 10.1164/rccm.201312-2257OC
Crossref
| Google Scholar
Fan E, Dowdy DW, Colantuoni E, Mendez-Tellez PA, Sevransky JE, Shanholtz C, et al. Physical complications in acute lung injury survivors: a two-year longitudinal prospective study. Crit Care Med. 2014 Apr;42(4):849-59. doi: 10.1097/CCM.0000000000000040
Crossref
| Google Scholar
Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2018 Sep;46(9):e825-e873.
Zang K, Chen B, Wang M, Chen D, Hui L, Guo S, et al. The effect of early mobilization in critically ill patients: A meta-analysis. Nurs Crit Care. 2020 Nov;25(6):360-367. doi: 10.1111/nicc.12455
Crossref
| Google Scholar
Wang J, Ren D, Liu Y, Wang Y, Zhang B, Xiao Q. Effects of early mobilization on the prognosis of critically ill patients: A systematic review and meta-analysis. Int J Nurs Stud. 2020 Oct;110:103708. doi: 10.1016/j.ijnurstu.2020.103708
Crossref
| Google Scholar
Tipping CJ, Harrold M, Holland A, Romero L, Nisbet T, Hodgson CL. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med. 2017 Feb;43(2):171-183. doi: 10.1007/s00134-016-4612-0
Crossref
| Google Scholar
Anekwe DE, Biswas S, Bussières A, Spahija J. Early rehabilitation reduces the likelihood of developing intensive care unit-acquired weakness: a systematic review and meta-analysis. Physiotherapy. 2020 Jun;107:1-10. doi: 10.1016/j.physio.2019.12.004
Crossref
| Google Scholar
Paton M, Lane R, Hodgson CL. Early Mobilization in the Intensive Care Unit to Improve Long-Term Recovery. Crit Care Clin. 2018 Oct;34(4):557-571. doi: 10.1016/j.ccc.2018.06.005
Crossref
| Google Scholar
Zorowitz RD. ICU-Acquired Weakness: A Rehabilitation Perspective of Diagnosis, Treatment, and Functional Management. Chest. 2016 Oct;150(4):966-971. doi: 10.1016/j.chest.2016.06.006
Crossref
| Google Scholar
Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009 May 30;373(9678):1874-82. doi: 10.1016/S0140-6736(09)60658-9
Crossref
| Google Scholar
Doiron KA, Hoffmann TC, Beller EM. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. Cochrane Database Syst Rev. 2018 Mar 27;3(3):CD010754. doi: 10.1002/14651858.CD010754.pub2
Crossref
| Google Scholar
Villalba D, Carini F. Rehabilitación física en la Unidad de Cuidados Intensivos. Revista Argentina de Terapia Intensiva 2018; 35: 39–45.
TEAM Study Investigators and the ANZICS Clinical Trials Group; Hodgson CL, Bailey M, Bellomo R, Brickell K, Broadley T, Buhr H, et al. Early Active Mobilization during Mechanical Ventilation in the ICU. N Engl J Med. 2022 Nov 10;387(19):1747-1758. doi: 10.1056/NEJMoa2209083
Crossref
| Google Scholar
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Rev Esp Cardiol (Engl Ed). 2021 Sep;74(9):790-799. English, Spanish.
Higgins JPT, Altman DG, Sterne JAC (editores). Capítulo 8: Evaluación del riesgo de sesgo en los estudios incluidos. En: Higgins JPT, Green S (editores). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (actualizado marzo 2011). The Cochrane Collaboration, 2011.
Kleyweg RP, van der Meché FG, Schmitz PI. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barré syndrome. Muscle Nerve. 1991 Nov;14(11):1103-9. doi: 10.1002/mus.880141111
Crossref
| Google Scholar
Bohannon RW. Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years. Arch Phys Med Rehabil. 1997 Jan;78(1):26-32. doi: 10.1016/S0003-9993(97)90005-8
Crossref
| Google Scholar
Campbell IT, Watt T, Withers D, England R, Sukumar S, Keegan MA, et al. Muscle thickness, measured with ultrasound, may be an indicator of lean tissue wasting in multiple organ failure in the presence of edema. Am J Clin Nutr. 1995 Sep;62(3):533-9. doi: 10.1093/ajcn/62.3.533
Crossref
| Google Scholar
Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J. 1965;14:61–65. doi: 10.1037/t02366-000
Crossref
| Google Scholar
Hamilton BB, Laughlin JA, Fiedler RC, Granger CV. Interrater reliability of the 7-level functional independence measure (FIM). Scand J Rehabil Med. 1994 Sep;26(3):115-9. doi: 10.2340/165019771994263115119
Crossref
| Google Scholar
Van Dillen LR, Roach KE. Reliability and validity of the Acute Care Index of Function for patients with neurologic impairment. Phys Ther. 1988 Jul;68(7):1098-101. doi: 10.1093/ptj/68.7.1098
Crossref
| Google Scholar
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002 Jul 1;166(1):111-7. doi: 10.1164/ajrccm.166.1.at1102. Erratum in: Am J Respir Crit Care Med. 2016 May 15;193(10):1185. doi: 10.1164/ajrccm.166.1.at1102
Crossref
| Google Scholar
Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA; Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011 Oct 18;343:d5928. doi: 10.1136/bmj.d5928
Crossref
| Google Scholar
Denehy L, Skinner EH, Edbrooke L, Haines K, Warrillow S, Hawthorne G, et al. Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months of follow-up. Crit Care. 2013 Jul 24;17(4):R156. doi: 10.1186/cc12835
Crossref
| Google Scholar
McWilliams D, Jones C, Atkins G, Hodson J, Whitehouse T, Veenith T et al. Earlier and enhanced rehabilitation of mechanically ventilated patients in critical care: A feasibility randomised controlled trial. J Crit Care 2018;44:407–412. doi: 10.1016/j.jcrc.2018.01.001
Crossref
| Google Scholar
Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schünemann HJ; GRADE Working Group. What is "quality of evidence" and why is it important to clinicians? BMJ. 2008 May 3;336(7651):995-8. doi: 10.1136/bmj.39490.551019.BE
Crossref
| Google Scholar
Schaller SJ, Anstey M, Blobner M, Edrich T, Grabitz SD, Gradwohl-Matis I, et al; International Early SOMS-guided Mobilization Research Initiative. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet. 2016 Oct 1;388(10052):1377-1388. doi: 10.1016/S0140-6736(16)31637-3
Crossref
| Google Scholar
Wright SE, Thomas K, Watson G, Baker C, Bryant A, Chadwick TJ, et al. Intensive versus standard physical rehabilitation therapy in the critically ill (EPICC): a multicentre, parallel-group, randomised controlled trial. Thorax. 2018 Mar;73(3):213-221. doi: 10.1136/thoraxjnl-2016-209858
Crossref
| Google Scholar
Morris PE, Berry MJ, Files DC, Thompson JC, Hauser J, Flores L, et al. Standardized Rehabilitation and Hospital Length of Stay Among Patients With Acute Respiratory Failure: A Randomized Clinical Trial. JAMA. 2016 Jun 28;315(24):2694-702. doi: 10.1001/jama.2016.7201
Crossref
| Google Scholar
Menges D, Seiler B, Tomonaga Y, Schwenkglenks M, Puhan MA, Yebyo HG. Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Crit Care. 2021 Jan 6;25(1):16. doi: 10.1186/s13054-020-03446-9
Crossref
| Google Scholar
Paton M, Chan S, Tipping CJ, Stratton A, Serpa Neto A, Lane R, Young PJ, Romero L, Broadley T, Hodgson CL. The Effect of Mobilization at 6 Months after Critical Illness - Meta-Analysis. NEJM Evid. 2023 Feb;2(2):EVIDoa2200234. doi: 10.1056/EVIDoa2200234
Crossref
| Google Scholar
Patel BK, Wolfe KS, Patel SB, Dugan KC, Esbrook CL, Pawlik AJ, et al. Effect of early mobilisation on long-term cognitive impairment in critical illness in the USA: a randomised controlled trial. Lancet Respir Med. 2023 Jun;11(6):563-572. doi: 10.1016/S2213-2600(22)00489-1
Crossref
| Google Scholar
Hodgson CL, Bailey M, Bellomo R, Berney S, Buhr H, Denehy L, et al; Trial of Early Activity and Mobilization Study Investigators. A Binational Multicenter Pilot Feasibility Randomized Controlled Trial of Early Goal-Directed Mobilization in the ICU. Crit Care Med. 2016 Jun;44(6):1145-52. doi: 10.1097/CCM.0000000000001643
Crossref
| Google Scholar
Kayambu G, Boots R, Paratz J. Early physical rehabilitation in intensive care patients with sepsis syndromes: a pilot randomised controlled trial. Intensive Care Med. 2015 May;41(5):865-74. doi: 10.1007/s00134-015-3763-8
Crossref
| Google Scholar
Dantas CM, Silva PF, Siqueira FH, Pinto RM, Matias S, Maciel C, Oliveira MC, Albuquerque CG, Andrade FM, Ramos FF, França EE. Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. Rev Bras Ter Intensiva. 2012 Jun;24(2):173-8. English, Portuguese. doi: 10.1590/S0103-507X2012000200013
Crossref
| Google Scholar
De Jonghe B, Bastuji-Garin S, Fangio P, Lacherade JC, Jabot J, Appéré-De-Vecchi C, et al. Sedation algorithm in critically ill patients without acute brain injury. Crit Care Med. 2005 Jan;33(1):120-7. doi: 10.1097/01.CCM.0000150268.04228.68
Crossref
| Google Scholar
Schweickert WD, Gehlbach BK, Pohlman AS, Hall JB, Kress JP. Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients. Crit Care Med. 2004 Jun;32(6):1272-6. doi: 10.1097/01.CCM.0000127263.54807.79
Crossref
| Google Scholar
Waldauf P, Jiroutková K, Krajčová A, Puthucheary Z, Duška F. Effects of Rehabilitation Interventions on Clinical Outcomes in Critically Ill Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Crit Care Med. 2020 Jul;48(7):1055-1065. doi: 10.1097/CCM.0000000000004382
Crossref
| Google Scholar
Skinner EH, Thomas P, Reeve JC, Patman S. Minimum standards of clinical practice for physiotherapists working in critical care settings in Australia and New Zealand: A modified Delphi technique. Physiother Theory Pract. 2016 Aug;32(6):468-482. doi: 10.3109/09593985.2016.1145311
Crossref
| Google Scholar
Fredes S, Tiribelli N, Setten M, Rodrigues R, Plotnikow G, Busico M, et al. Definición del rol y las competencias del kinesiólogo en la Unidad de Cuidados Intensivos. Revista Argentina de Terapia Intensiva 2018; 35 (4): 1-12.
Hodgson CL, Kho ME, da Silva VM. To mobilise or not to mobilise: is that the right question? Intensive Care Med. 2023 Aug;49(8):1000-1004. doi: 10.1007/s00134-023-07088-7
Crossref
| Google Scholar
