Journal Article

Early versus delayed mobilization for in-hospital mortality and health-related quality of life among critically ill patients: a systematic review and meta-analysis

Okada, Yohei, Matsuishi, Yujiro, Egawa, Yuko, Inoue, Shigeaki, Unoki, Takeshi, Hayashida, Kei

2019

Overview

Background This systematic review and meta-analysis of randomized clinical trials aimed to investigate the efficacy of early mobilization among critically ill adult patients. Methods We searched CENTRAL, MEDLINE, and Igaku-Chuo-Zasshi (a Japanese bibliographic database) databases until April 2019 and included randomized control trials to compare early mobilization started within 1 week of intensive care unit (ICU) admission and earlier-than-usual care with the usual care or mobilization initiated later than the intervention. Two authors independently extracted the data of the included studies and assessed their quality. The primary outcomes were in-hospital mortality, length of ICU/hospital stay, and health-related quality of life (QOL). Results Among 1085 titles/abstracts screened, 11 studies (including 1322 patients) were included in the meta-analysis, which was conducted using the random-effects model. The pooled relative risk for in-hospital mortality comparing early mobilization to usual care (control) was 1.12 (95% CI [confidence interval]: 0.80 to 1.58, I 2 = 0%). The pooled mean differences for duration of ICU and hospital stay were -1.54 (95% CI: -3.33 to 0.25, I 2 = 90%) and -2.86 (95% CI: -5.51 to -0.21, I 2 = 85%), respectively. The pooled mean differences at 6 months post-discharge, as measured by the Short Form 36-Item Health Survey and Euro-QOL EQ-5D, were 4.65 (95% CI: -16.13 to 25.43, I 2 = 86%) for physical functioning and 0.29 (95% CI: -11.19 to 11.78, I 2 = 66%) for the visual analog scale. Conclusions Our study indicated no apparent differences between early mobilization and usual care in terms of in-hospital mortality and health-related QOL. Detailed larger studies are warranted to evaluate the impact of early mobilization on in-hospital mortality and health-related QOL in critically ill patients. Trial registration PROSPERO (identifier CRD42019139265 )

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Analysis / Bias / Bibliographic data bases / Cognitive ability / Collaboration / Confidence intervals / Critical care / Critical Care Medicine / Early mobilization / Health surveys / Intensive / Intensive care / Intervention / Japan / Medical research / Medicine / Medicine & Public Health / Meta-analysis / Mortality / Occupational therapy / Online databases / Patients / Physical therapy / Physiotherapy / Quality of life / Rehabilitation / Systematic review