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Rehabilitation Interventions for Postintensive Care Syndrome

A Systematic Review*

Mehlhorn, Juliane MD1; Freytag, Antje PhD1; Schmidt, Konrad MD1; Brunkhorst, Frank M. MD2,3; Graf, Juergen MD4; Troitzsch, Ute5; Schlattmann, Peter PhD6; Wensing, Michel PhD1,7; Gensichen, Jochen MD, MPH, MSc1

doi: 10.1097/CCM.0000000000000148
Review Articles

Objective: An increasing number of ICU patients survive and develop mental, cognitive, or physical impairments. Various interventions support recovery from this postintensive care syndrome. Physicians in charge of post-ICU patients need to know which interventions are effective.

Data Sources: Systematic literature search in databases (MEDLINE, EMBASE, Cochrane CENTRAL, PsycInfo, CINAHL; 1991–2012), reference lists, and hand search.

Study Selection: We included comparative studies of rehabilitation interventions in adult post-ICU patients if they considered health-related quality of life, frequency/severity of postintensive care syndrome symptoms, functional recovery, need for care, autonomy in activities of daily living, mortality, or hospital readmissions.

Data Extraction: Two reviewers extracted data and assessed risk of bias independently.

Data Synthesis: From 4,761 publications, 18 studies with 2,510 patients were included. Studies addressed 20 outcomes, using 45 measures, covering inpatient (n = 4 trials), outpatient (n = 9), and mixed (n = 5) healthcare settings. Eight controlled trials with moderate to high quality were considered for evaluation of effectiveness. They investigated inpatient geriatric rehabilitation, ICU follow-up clinic, outpatient rehabilitation, disease management, and ICU diaries. Five of these trials assessed posttraumatic stress disorder, with four trials showing positive effects: first, ICU diaries reduced new-onset posttraumatic stress disorder (5% vs 13%, p = 0.02) after 3 months and second showed a lower mean Impact of Event Scale-Revised score (21.0 vs 32.1, p = 0.03) after 12 months. Third, aftercare by ICU follow-up clinic reduced Impact of Event Scale for women (20 vs 31; p < 0.01). Fourth, a self-help manual led to fewer patients scoring high in the Impact of Event Scale after 8 weeks (p = 0.026) but not after 6 months. For none of the other outcomes did more than one study report positive impacts.

Conclusion: Interventions which have substantial effects in post-ICU patients are rare. Positive effects were seen for ICU-diary interventions for posttraumatic stress disorder. More interventions for the growing number of ICU survivors are needed.

1Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.

2Paul-Martini-Research Group, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.

3Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.

4Medical Directorate, Central Hospital Stuttgart, Stuttgart, Germany.

5Thuringian State and University Library, Jena, Germany.

6Department of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany.

7Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

* See also p. 1320.

This study was performed at Institute of General Practice and Family Medicine, Friedrich Schiller University/Jena University Hospital, Jena, Germany.

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Dr. Mehlhorn and Dr. Gensichen received support for article research: German Center for Sepsis Control & Care, funded by the Ministry of Education and Research (BMBF), grant no. 01 E0 1002. Dr. Brunkhorst received support for article research from the German Ministry of Education and Research and the Ministry of Thuringia (ProExcellence; PE 108-2); the Thuringian Foundation for Technology, Innovation and Research (STIFT); and the German Sepsis Society. Dr. Brunkhorst received support for article research from the German Ministry of Education and Research. Dr. Wensing receives a consulting fee from the Institute of General Practice and Family Medicine, Friedrich Schiller University/Jena University Hospital for scientific advice. He consulted for University Hospital Jena, Department General Practice (scientific advisor role). The funders played no role in the design of the systematic review, its data collection, analysis, interpretation of data, writing the report, or the decision for publication of the paper. They are not responsible for the contents of this review. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins