Impacts of non-pharmacological interventions on post-intensive care syndrome: An umbrella review of systematic reviews and meta-analyses of randomized controlled trials

Abstract

Objectives: To assess the effects of various non-pharmacological interventions on long-term outcomes associated with Post-Intensive Care Syndrome (PICS) in intensive care unit (ICU) survivors, based on existing systematic reviews and meta-analyses.

Methods: An umbrella review was conducted. Comprehensive searches of PubMed, Web of Science, Embase, and the Cochrane Library databases were performed up to June 2025 to identify eligible reviews. Two authors independently conducted article selection and data extraction. The methodological quality of the included studies was assessed using the AMSTAR 2 measurement tool. Results were synthesized narratively, and grouped by prevention or care focus.

Results: Nine systematic reviews published between 2015 and 2023 encompassing 112 randomized controlled trials and 19,996 ICU survivors were included. The interventions evaluated comprised early mobilization (three reviews), follow-up consultation (two reviews), and other non-pharmacological strategies (four reviews), including ICU diaries, exercise rehabilitation, oxygen therapy, and nurse-led interventions. Reported outcomes covered physical function (activities of daily living, exercise capacity, pulmonary function, muscle strength, and pain), psychological function (anxiety, depression, post-traumatic stress disorder [PTSD]), cognitive function, social reintegration (return to work), and quality of life. According to the evidence map, ICU diaries demonstrated a consistently beneficial effect on PTSD, while follow-up consultations yielded inconsistent results for PTSD. Early mobilization interventions produced variable improvements in physical function and quality of life across studies. Exercise rehabilitation was associated with enhanced physical performance, whereas oxygen therapy strategies showed no significant effects. Nurse-led interventions demonstrated beneficial effects on anxiety and depression. Overall, 78% of the assessed outcomes were rated as low or very low certainty due to methodological heterogeneity and limited sample sizes.

Conclusions: Current evidence on non-pharmacological interventions for PICS remains heterogeneous and of generally low certainty. These findings highlight the urgent need for high-quality, adequately powered randomized studies to establish the effectiveness of these interventions and guide evidence-based PICS management.

Implications for clinical practice: Clinical practice should emphasize integrated, transitional care pathways that combine ICU diary-based psychological support with individualized mobilization and rehabilitation programs. Establishing standardized core outcome sets and improving methodological rigor in intervention trials will be key to advancing evidence-informed PICS management.

Keywords: Intensive care units; Mental impairment; Physical impairment; Post-intensive care syndrome; Umbrella review.