Clinical impact of rehabilitation and ICU diary on critically ill patients: A systematic review and meta-analysis

Background: Various physical and mental sequelae reduce the quality of life (QOL) of intensive care unit (ICU) patients. Current guidelines recommend multi-angular approaches to prevent these sequelae. Some studies have demonstrated the clinical effectiveness of rehabilitation or the ICU diary against these sequelae, whereas others have not.Aim: The aims of the present study were to establish whether rehabilitation or the ICU diary was useful for reducing the severity of anxiety, depression, and post-traumatic stress disorder (PTSD) in ICU patients. We also investigated whether these interventions improved the QOL of these patients.Study design: We conducted a systematic review and meta-analysis of relevant randomized controlled trials published between January 1, 1985, and October 19, 2022, with the following search engines: PubMed, CHINAHL, all Ovid journals, and CENTRAL. The hospital anxiety and depression scale (HADS), the short-form health survey (SF-36), the EuroQol 5-dimensions, 5-levels (EQ-5D-5L), and the Impact of Event Scale-Revised (IES-R) were used as outcome measures. The quality of evidence across all studies was independently assessed using Review Manager software (v.5.4).Results: We included 12 rehabilitation studies and five ICU diary studies. Rehabilitation had no significant effects on HADS-anxiety, HADS-depression, or EQ-5D-5L, but significantly improved the physical component summary (PCS) [MD = 3.31, 95% CI (1.33 to 5.28), p = .001] and mental component summary (MCS) [MD = 4.31, 95% CI: (1.48 to 7.14), p = .003] of the SF-36. The ICU diary significantly ameliorated HADS-anxiety [MD = 0.96, 95%CI: (0.21 to 1.71), p = .01], but did not affect HADSdepression, the IES-R, or the PCS or MCS of the SF-36.Conclusions: The present study showed that rehabilitation initiated after discharge from the ICU effectively improved SF-36 scores. The ICU diary ameliorated HADSanxiety. Neither rehabilitation nor the ICU diary attenuated HADS-depression or IES-R in this setting. Rehabilitation and the ICU diary partially improved the long-term prognosis of ICU patients.Relevance to clinical practice: The present study provides evidence for the beneficial effects of rehabilitation and the ICU diary for ICU patients. Rehabilitation alone does not ameliorate anxiety, depression, or PTSD symptoms, but may improve QOL. The ICU diary only appeared to ameliorate anxiety.