Early rehabilitation to prevent postintensive care syndrome in patients with critical illness: a systematic review and meta-analysis.
Early rehabilitation to prevent postintensive care syndrome in patients with critical illness: a systematic review and meta-analysis.
复制标题
DOI：
10.1136/bmjopen-2017-019998
复制
发表时间：
2018-05-05
期刊：
影响因子：
2.9
通讯作者：
Nishida O
中科院分区：
文献类型：
--
作者：
Fuke R;Hifumi T;Kondo Y;Hatakeyama J;Takei T;Yamakawa K;Inoue S;Nishida O
我们研究了早期康复对于预防重病幸存者中重症监护后综合症（PICS）的有效性，该综合症的特点是身体、认知或心理健康状况受损。我们对多个数据库（Medline、Embase 和 Cochrane 对照试验中央注册库）进行了系统文献检索，并进行了手动检索，以识别随机对照试验 (RCT)，比较早期康复与不进行早期康复或标准护理预防 PICS 的有效性。主要结局是住院期间评估的短期身体相关、认知相关和心理健康相关结局。次要结局是标准化的长期健康相关生活质量评分（EuroQol 5 Dimension (EQ5D) 和医疗结果研究 36 项简短健康调查身体功能量表 (SF-36 PF)）。我们使用建议评估、制定和评估分级方法来评估证据质量 (QoE)。包括从 5105 份筛选摘要中选出的 6 项随机对照试验。早期康复显着改善了短期身体相关结局，医学研究理事会量表评分增加（标准化均数差 (SMD)：0.38，95% CI 0.10 至 0.66，p=0.009）（QoE：低），重症监护病房获得性无力的发生率降低（OR 0.42，95% CI 0.22 至 0.82， p=0.01，QoE：低），与标准护理或无早期康复相比。然而，两组在认知相关的无谵妄天数（SMD：-0.02，95％CI -0.23至0.20，QoE：低）和心理健康相关的医院焦虑和抑郁量表评分（OR：0.79，95％CI 0.29至2.12，QoE：低）方面没有差异。早期康复并没有改善以 EQ5D 和 SF-36 PF 为特征的 PICS 的长期结果。早期康复只能改善危重患者的短期身体相关结局。需要额外的大型随机对照试验。
We examined the effectiveness of early rehabilitation for the prevention of postintensive care syndrome (PICS), characterised by an impaired physical, cognitive or mental health status, among survivors of critical illness. We performed a systematic literature search of several databases (Medline, Embase and Cochrane Central Register of Controlled Trials) and a manual search to identify randomised controlled trials (RCTs) comparing the effectiveness of early rehabilitation versus no early rehabilitation or standard care for the prevention of PICS. The primary outcomes were short-term physical-related, cognitive-related and mental health-related outcomes assessed during hospitalisation. The secondary outcomes were the standardised, long-term health-related quality of life scores (EuroQol 5 Dimension (EQ5D) and the Medical Outcomes Study 36-Item Short Form Health Survey Physical Function Scale (SF-36 PF)). We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate the quality of evidence (QoE). Six RCTs selected from 5105 screened abstracts were included. Early rehabilitation significantly improved short-term physical-related outcomes, as indicated by an increased Medical Research Council scale score (standardised mean difference (SMD): 0.38, 95% CI 0.10 to 0.66, p=0.009) (QoE: low) and a decreased incidence of intensive care unit-acquired weakness (OR 0.42, 95% CI 0.22 to 0.82, p=0.01, QoE: low), compared with standard care or no early rehabilitation. However, the two groups did not differ in terms of cognitive-related delirium-free days (SMD: −0.02, 95% CI −0.23 to 0.20, QoE: low) and the mental health-related Hospital Anxiety and Depression Scale score (OR: 0.79, 95% CI 0.29 to 2.12, QoE: low). Early rehabilitation did not improve the long-term outcomes of PICS as characterised by EQ5D and SF-36 PF. Early rehabilitation improved only short-term physical-related outcomes in patients with critical illness. Additional large RCTs are needed.
登录
查看更多内容
DOI：
10.1164/rccm.201505-1039oc
发表时间：
2016-05-15
影响因子：
24.7
作者：
Moss, Marc;Nordon-Craft, Amy;Schenkman, Margaret
通讯作者：
Schenkman, Margaret
影响因子：
2.1
作者：
Mozzi, Adelaide;Meregaglia, Michela;Fattore, Giovanni
通讯作者：
Fattore, Giovanni
影响因子：
3.2
作者：
Bemis-Dougherty, Anita R.;Smith, James M.
通讯作者：
Smith, James M.
影响因子：
8.8
作者：
Hodgson, Carol L.;Bailey, Michael;Webb, Steven
通讯作者：
Webb, Steven
影响因子：
38.9
作者：
Kayambu, Geetha;Boots, Robert;Paratz, Jennifer
通讯作者：
Paratz, Jennifer