Post Hospital Discharge Functional Recovery of Critical Illness Survivors. Systematic Review

Patsaki, Irini; Bachou, Georgia; Sidiras, Georgios; Nanas, Serafim; Routsi, Christina; Karatzanos, Eleftherios

doi:10.2478/jccm-2023-0011

Figures & Tables

Description of the studies included in the systematic-review_

Study	Group (N) APACHE-II	Intervention	Configuration	Duration	Outcomes
Batterham et al. (2014)	CG:30APACHE-II:16.4(7.8)IG:29APACHE-II:15.9(7.9)	CG: Standard care(medical follow-up, no rehabilitation)IG : Program with cycle ergometer 30′ of moderate intensity, 2 supervised sessions/1 unsupervised	SF-36 (PF)	9 weeksFollow up: 26 weeks	SF-36 (PF): IG : 43.5 (18)vs CG: 40.1(23),95% confidence interval [-1.4-8.2])
Battle et al. (2018)	CG :30APACHE-II:15 (12-19)IG :30APACHE-II:13 (9-19)	CG : Standard care (no rehabilitation prescription)IG : Personalized supervised exercise program in an outpatient gym	6MWT, Berg balance, HG	6 weeks afterhospital Followup:7 weeks, 6months, 12 months	At 6 weeks6MWT: IG:379.3(207.9) vs CG:283.6(229.3), p=0.491Berg :IG :53.4(6.2) vs CG:50.5 (7.0), p=0.99HG(L): IG:20.7(11.4) vs19.5(12.5),p=0.287
Connolly et al. (2015)	CG :10APACHE-II:23.5 (21-30.3)IG :10APACHE-II:24.5(18.8-29.5)	CG: Weekly telephone follow-upIG: 16 sessions in an outpatient gym	ISWT, 6MWT, SF-36 (PCS),	3 months afterhospital	Change in outcomesISWT(m): CG: 170(40-315)vs IG: 115(-2.5-237.5)6MWT(m):CG:185(40-285)vs IG:140(35.8-210.3)PCS: CG: 11(4.3-28.3) vs IG:1.8 (-6.8-15.9)
Elliot et al. (2011)	CG: 91APACHE-II:19.5(7.2)IG: 92APACHE-II:19.4(12.6)	CG : Standard care (medical follow-up)IG : Home rehabilitation program with an emphasis on increasing muscle strength & walking	SF-36 (PF), 6MWT	8 weeksFollow up:26 weeks	SF-36 (PF) :IG :39.9 vs CG :41.0, p<0.05,while the effect time was notable for PF (p=0,034) and for 6MWT(p=0,0003).
McDowell et al. (2016)	CG : 30APACHE-II:15.2(5.6)IG : 30APACHE-II:17.3 (7.7)	CG : Standard care(no support)IG : personalized exercise program in the hospital gym (supervised-2 sessions) or at home (unsupervised-1 session)	SF-36(PF),ISWT HG	6 weeksFollow up: 6 months	SF-36(PF) :IG :6.8(10.9) vs CG:3.9(8.2),p=0,26ISWT : IG :135.5(119.8) vs CG:52.4(126.7),p=0.03HG(dominant): IG:6.1(28.1)vs CG:12.5(22.8), p=0.39
McWilliams et al. (2016)	CG :36APACHE-II:15.9(5.3)IG :37APACHE-II:16.6(5.7)	CG : Standard care (no exercise prescription or consultation)IG : supervised session with a 10-station program-cardiovascular exercises	SF-36 (PCS),	7 weeks	Degree of improvement SF-36 (PF) IG :3.5(95% CI;1.6-6.7 vs CG :8.6(95%;5.4-10.6), p=0,048)
Vitacca et al. (2016)	CG :24IG :24	OE: Standard care (medical support, free to conduct physical activity without monitoring or support)IG : pulmonary rehabilitation program at home under supervision	MIP/MEP, BADL, MRC-SS,	6 months	MIP: IG : +33cm H2O vs CG : +26cm H2O,p<0.03MEP :IG : +42cm H2O vs CG : +28cm H2O, p<0.03BADL: p=0.63Biceps MRC-SS: p=0.07Quadriceps MRC-ss:p=0.53
Veldema et al. (2019)	CG : 14IG : a)13b)12	OE: Standard careIG : a) cycle ergometer program, b) resistance program(inpatients in a neurological rehabilitation clinic) 5times/week, 4 sets of 15 repititions	FAC, TUG test, 10MWT, MMS test SF-36(PF)	2 weeks4 weeks	6MWT (4 weeks): p<0.05 within groupsTUG(4weeks):p<0.05 within groupsFAC(2weeks):p<0.05 between groupsMRC knee flexion (2weeks): p<0.05 between groups
Shelly et al (2017)	CG:18, IG:17	IG: 4 weeks unsupervised home rehabilitation programCG: no exercise prescrition	SF-36 (PF)	4weeks	SF-36 (PF ): IG: 10.32(8.51-14.92) vs CG: 7.36(3.68-8.48), p=0.003

Description of the rehabilitation program that the intervention group followed_

Study	Duration / Intensity / Frequency	Intervention
Batterham et al. (2014)	Duration: 30 minutes	Cardiorespiratory exercises: cycle ergometer (12-14 Borg Scale)
	Intensity: moderate and progressively increasing	3 minutes at 60rpm and 3 minutes break
	Frequency: 2 times/week	Pedal resistance increased by 10 and 20W/min (The program included warm-up and recovery)
Battle et al. (2018)	Duration: 60 minutes	Cardiorespiratory exercises: cycle ergometer, treadmill, rowing machines
	Intensity: progressively increasing	Muscle strength and balance exercises with strength balls and bands, weights
	Frequency: 2 times/week	Functional balance exercises in a sitting and standing position, balance board
Connolly et al. (2015)	Duration: 40 minutes	Cardiorespiratory exercises
	Intensity: progressively increasing	Exercises to strengthen upper and lower limb muscle strength
	Frequency: 2 times/week	Balance exercises
	Frequency: 2 times/week	Functional exercises (The program included warm-up and recovery)
Elliot et al. (2011)	Duration: 20-30 minutes	Cardiorespiratory exercises-5 exercises (walking at 80% walking speed)
	Intensity: moderate to heavy (progressively increasing)	Core stabilization exercises (3 exercises)
	Intensity: moderate to heavy (progressively increasing)	Upper-lower limb strengthening exercises with weights (8 reps/3 sets with progressive weight increase from 0.25 to 1.5 kg)
	Frequency: 5 times/week	Flexibility exercises and stretching (3 exercises and 4 respectively) (Total 16 different exercises)
Mcdowell et al. (2016)	Duration: 60 minutes	Strengthening exercises (10 repetitions upper-lower limbs-trunk and stretching exercises)
	Intensity: moderate-gradually increasing	Cardiorespiratory exercises: walking, cycle ergometer, treadmill (from 10-30 minutes and 3-4 Borg)
	Frequency: 3 times/week	(The program included warm-up and recovery)
McWilliams et al. (2016)	Duration: 20 minutes	Circuit Training 10 stations [(1 minute exercise/statìon)*2] (3-4 Borg)
	Intensity: moderate-progressively increasing
	Frequency: 3 times/week
Vitacca et al. (2016)	Duration: 60 minutes	Program of passive-active and assisted exercises (increasing range of motion-passive transfers-standing-stand-up/sit down)
	Intensity: progressively increasing	Breathing exercises (2 sessions daily-breathing cycle-chest expansion-violent breathing-coughing)
	Frequency: 6 times/week
		Balance exercises
		Application of electroneuromuscular stimulation to the lower limbs
		Cardiorespiratory exercises: cycle ergometer, treadmill
		Strengthening exercises
Veldema et al. (2019)	Duration: 20 minutes	Cardiorespiratory exercises: cycle ergometer (13 Borg Scale)
	Intensity: moderate to heavy-progressively increasing	Strength exercises with weights (4 sets/15 repetitions with a 30-40” rest)
	Frequency: 5 times/week
Shelly et al. (2017)	Duration: 30-40 minutes	Ambulation
	Frequency: 5 times/week	Exercises on bed (each exercise 10times/per set)
	Ambulation twice a day (11-13 on Borg scale)	Respiratory exercises
	Ambulation twice a day (11-13 on Borg scale)	Dynamic quadriceps

Quality of the RCT studies of stroke patients on Pedro Scale (item1 doesn’t contribute to total score)

	Batterham et al (2014)	Battle et al (2018)	Connolly et al (2015)	Elliott et al (2011)	McDowell et al (2016)	McWilliams et al (2016)	Vitacca et al (2016)	Veldema et al (2019)	Shelly et al (2017)
1	√	√	√	√	√	√	√	√	√
2		√	√	√	√	√	√	√	√
3	√	√		√	√				√
4		√		√	√	√			√
5				√
6	√						√
7	√	√			√	√		√
8				√	√	√		√
9
10	√	√	√	√	√	√	√	√	√
11	√	√	√	√	√	√	√	√	√
Total	6/10	7/10	4/10	8/10	8/10	7/10	5/10	6/10	5/10

Post Hospital Discharge Functional Recovery of Critical Illness Survivors. Systematic Review

Figures & Tables

Fig. 1.

Description of the studies included in the systematic-review_

Description of the rehabilitation program that the intervention group followed_

Quality of the RCT studies of stroke patients on Pedro Scale (item1 doesn’t contribute to total score)

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