Objective: To systematically evaluate the effect of early systematic rehabilitation on muscle strength and prognosis of patients undergoing mechanical ventilation in intensive care unit (ICU).
Methods: Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure (CNKI), VIP database (VIP) and Wanfang database were searched by computer for randomized controlled trial (RCT) on early systematic rehabilitation of patients undergoing mechanical ventilation in ICU published from the establishment of the database to October 2022. The observation group was given early systematic rehabilitation, while the control group was given routine activities. The outcome indicators included Medical Research Council muscle strength score (MRC score), incidence of ICU-acquired weakness (ICU-AW), 36-item short form health survey scale (SF-36), length of hospital stay, and hospital mortality. Two researchers independently screened the literature, extracted the data, and evaluated the quality of the literature to conduct a Meta-analysis of the studies that met the quality criteria. Funnel plot was used to analyze the publication bias of each study.
Results: A total of 14 articles were enrolled, 13 in English and 1 in Chinese. A total of 1 835 patients were involved, including 922 cases in the observation group and 913 cases in the control group. The overall literature quality was good. Compared with the control group, the incidence of ICU-AW in the observation group was significantly reduced [relative risk (RR) = 0.78, 95% confidence interval (95%CI) was 0.62-0.98, P < 0.05], but the MRC score was not significantly increased [weighted mean difference (WMD) = 2.51, 95%CI was 0.77-4.25, P = 0.05]. There were no significant differences in ICU mortality (RR = 1.05, 95%CI = 0.59-1.87, P > 0.05), hospital mortality (RR = 1.15, 95%CI was 0.76-1.74, P > 0.05), length of ICU stay (WMD = -3.02, 95%CI was -7.29-1.24, P > 0.05), total length of hospital stay (WMD = -3.67, 95%CI was -8.04-0.70, P > 0.05), and physical component summary (PCS; WMD = 1.83, 95%CI was -0.28-3.93, P > 0.05) and mental component summary (MCS; WMD = 1.72, 95%CI was -0.76-4.20, P > 0.05) of SF-36 scale at 6 months after discharge between the two groups. It was shown by funnel plot that the publication bias of each literature was relatively small, manifested as the effect points included in the literature were basically in a "inverted funnel" shape and symmetrical, in terms of MRC score, incidence of ICU-AW, mortality, length of hospital stay and scores of SF-36 scale.
Conclusions: Early systematic rehabilitation can significantly reduce the incidence of ICU-AW, without increasing the mortality, and has no significant improvement on muscle strength and physical function.