Effects of early mobilization on the prognosis of critically ill patients: A systematic review and meta-analysis

Abstract

Background: Early mobilization is considered a safe and effective therapeutic strategy for accelerating the rehabilitation of patients admitted to the intensive care unit, with a proven benefit for critically ill patients.

Objectives: To evaluate the effects of early mobilization on the prognosis of critically ill patients through a meta-analysis of data pooled from studies meeting the inclusion criteria.

Design: Systematic review and meta-analysis.

Data source: Electronic databases including PubMed, EMBASE, the Cochrane Library, CINAHL, ProQuest, Web of Science, ProQuest Dissertations and Theses, Chinese BioMedical Literature Service System, WANFANG database, CNKI database, and Clinical Trial Register Platform were systematically searched from inception up to December 31, 2019.

Review methods: Study eligibility was independently evaluated by two researchers. The title and abstract of the studies were first screened, and full-text articles of the remaining studies were screened for verification. Methodologic quality and risk of bias of the included studies were evaluated, and data were extracted from eligible studies. The meta-analysis was conducted using Review Manager v5.3 software. Key outcomes are presented as pooled risk ratio, weighted mean difference, and the corresponding 95% confidential interval .

Results: A total of 39 articles were included in the meta-analysis. The results showed that early mobilization improved ventilator-associated pneumonia patients' Medical Research Council score; reduced the incidence of intensive care unit-acquired weakness and intensive care unit-related complications such as ventilator-associated pneumonia, deep vein thrombosis, and pressure sores; and shortened the duration of mechanical ventilation, length of intensive care unit stay and hospital stay. However, there were no statistically significant differences in handgrip strength, delirium rate, intensive care unit mortality, hospital mortality, and physical function- and mental health-related quality of life at 2-3 months and 6 months post-hospital discharge.

Conclusions: Early mobilization was effective in enhancing the recovery of critically ill patients, but more large-scale, multicenter randomized controlled trials are required to further confirm these findings.

Keywords: Critically ill patients; Early mobilization; Meta-analysis; Prognosis; Systematic review.