Meta-Analysis

. 2023 Oct 1;51(10):1373-1385.

doi: 10.1097/CCM.0000000000005936. Epub 2023 May 30.

Responsiveness of Critically Ill Adults With Multimorbidity to Rehabilitation Interventions: A Patient-Level Meta-Analysis Using Individual Pooled Data From Four Randomized Trials

Jennifer R A Jones^{1

2

3}, Amalia Karahalios⁴, Zudin A Puthucheary^{5

6}, Michael J Berry⁷, D Clark Files^{8

9}, David M Griffith^{10

11}, Luke A McDonald², Peter E Morris¹², Marc Moss¹³, Amy Nordon-Craft¹⁴, Timothy Walsh^{10

15

16}, Sue Berney^{1

2}, Linda Denehy^{1

17

18}

Affiliations

¹ Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia.
² Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia.
³ Institute of Breathing and Sleep, Heidelberg, Victoria, Australia.
⁴ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
⁵ William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England, United Kingdom.
⁶ Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, England, United Kingdom.
⁷ Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC.
⁸ Pulmonary, Critical Care, Allergy and Immunologic Disease, Wake Forest University, Winston-Salem, NC.
⁹ Wake Forest Critical Illness Injury and Recovery Research Center, Wake Forest University, Winston Salem, NC.
¹⁰ Deanery of Molecular, Genetic and Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom.
¹¹ Royal Infirmary of Edinburgh, NHS (National Health Service) Lothian, Edinburgh, Scotland, United Kingdom.
¹² Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL.
¹³ Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO.
¹⁴ Physical Therapy Program, University of Colorado School of Medicine, Aurora, CO.
¹⁵ Anaesthetics, Critical Care, and Pain Medicine, School of Clinical Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom.
¹⁶ Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom.
¹⁷ Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.
¹⁸ Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.

PMID: 37246922
DOI: 10.1097/CCM.0000000000005936

Meta-Analysis

Responsiveness of Critically Ill Adults With Multimorbidity to Rehabilitation Interventions: A Patient-Level Meta-Analysis Using Individual Pooled Data From Four Randomized Trials

Jennifer R A Jones et al. Crit Care Med. 2023.

. 2023 Oct 1;51(10):1373-1385.

doi: 10.1097/CCM.0000000000005936. Epub 2023 May 30.

Authors

Affiliations

¹ Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia.
² Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia.
³ Institute of Breathing and Sleep, Heidelberg, Victoria, Australia.
⁴ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
⁵ William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England, United Kingdom.
⁶ Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, England, United Kingdom.
⁷ Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC.
⁸ Pulmonary, Critical Care, Allergy and Immunologic Disease, Wake Forest University, Winston-Salem, NC.
⁹ Wake Forest Critical Illness Injury and Recovery Research Center, Wake Forest University, Winston Salem, NC.
¹⁰ Deanery of Molecular, Genetic and Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom.
¹¹ Royal Infirmary of Edinburgh, NHS (National Health Service) Lothian, Edinburgh, Scotland, United Kingdom.
¹² Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL.
¹³ Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO.
¹⁴ Physical Therapy Program, University of Colorado School of Medicine, Aurora, CO.
¹⁵ Anaesthetics, Critical Care, and Pain Medicine, School of Clinical Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom.
¹⁶ Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom.
¹⁷ Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.
¹⁸ Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.

PMID: 37246922
DOI: 10.1097/CCM.0000000000005936

Abstract

Objective: To explore if patient characteristics (pre-existing comorbidity, age, sex, and illness severity) modify the effect of physical rehabilitation (intervention vs control) for the coprimary outcomes health-related quality of life (HRQoL) and objective physical performance using pooled individual patient data from randomized controlled trials (RCTs).

Data sources: Data of individual patients from four critical care physical rehabilitation RCTs.

Study selection: Eligible trials were identified from a published systematic review.

Data extraction: Data sharing agreements were executed permitting transfer of anonymized data of individual patients from four trials to form one large, combined dataset. The pooled trial data were analyzed with linear mixed models fitted with fixed effects for treatment group, time, and trial.

Data synthesis: Four trials contributed data resulting in a combined total of 810 patients (intervention n = 403, control n = 407). After receiving trial rehabilitation interventions, patients with two or more comorbidities had HRQoL scores that were significantly higher and exceeded the minimal important difference at 3 and 6 months compared with the similarly comorbid control group (based on the Physical Component Summary score (Wald test p = 0.041). Patients with one or no comorbidities who received intervention had no HRQoL outcome differences at 3 and 6 months when compared with similarly comorbid control patients. No patient characteristic modified the physical performance outcome in patients who received physical rehabilitation.

Conclusions: The identification of a target group with two or more comorbidities who derived benefits from the trial interventions is an important finding and provides direction for future investigations into the effect of rehabilitation. The multimorbid post-ICU population may be a select population for future prospective investigations into the effect of physical rehabilitation.

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Conflict of interest statement

Dr. Puthucheary reports honorarium and speaker fees from Baxter, Faraday Pharmaceuticals, Lyric Pharmaceuticals, Fresenius-Kabi, Nestle, Orion, GlaxoSmithKline, and Nutritica. Dr. Files reports consulting fees from Cytovale. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

Physical Therapy in the ICU-Is It Time to Consider Individualized Therapy Plans?
Rewa OG. Rewa OG. Crit Care Med. 2023 Oct 1;51(10):1445-1447. doi: 10.1097/CCM.0000000000005966. Epub 2023 Sep 14. Crit Care Med. 2023. PMID: 37707385 No abstract available.

References

1. Tipping CJ, Harrold M, Holland A, et al.: The effects of active mobilisation and rehabilitation in ICU on mortality and function: A systematic review. Intensive Care Med 2017; 43:171–183
1. Denehy L, Skinner EH, Edbrooke L, et al.: Exercise rehabilitation for patients with critical illness: A randomized controlled trial with 12 months of follow-up. Crit Care 2013; 17:R156
1. Moss M, Nordon-Craft A, Malone D, et al.: A randomized trial of an intensive physical therapy program for patients with acute respiratory failure. Am J Respir Crit Care Med 2016; 193:1101–1110
1. Walsh TS, Salisbury LG, Merriweather JL, et al.; RECOVER Investigators: Increased hospital-based physical rehabilitation and information provision after intensive care unit discharge: The RECOVER randomized clinical trial. JAMA Intern Med 2015; 175:901–910
1. Jones JRA, Berney S, Connolly B, et al.: Socioeconomic position and health outcomes following critical illness: A systematic review. Crit Care Med 2019; 47:e512–e521

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Responsiveness of Critically Ill Adults With Multimorbidity to Rehabilitation Interventions: A Patient-Level Meta-Analysis Using Individual Pooled Data From Four Randomized Trials

Affiliations

Responsiveness of Critically Ill Adults With Multimorbidity to Rehabilitation Interventions: A Patient-Level Meta-Analysis Using Individual Pooled Data From Four Randomized Trials

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources