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Highly Accessed Open Badges Review

Exercise rehabilitation following hospital discharge in survivors of critical illness: an integrative review

Bronwen Connolly12, Linda Denehy3, Stephen Brett4, Doug Elliott5 and Nicholas Hart126*

Author Affiliations

1 Department of Asthma, Allergy and Respiratory Science, Division of Asthma, Allergy and Lung Biology, King's College London, London SE1 9RT, UK

2 Guy's and St Thomas' NHS Foundation Trust and King's College London, National Institute of Health Research Comprehensive Biomedical Research Centre, London SE1 9RT, UK

3 Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, 3010 Australia

4 Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, London W12 0HS, UK

5 Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Sydney, 2007 Australia

6 Lane Fox Respiratory Unit, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK

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Critical Care 2012, 16:226  doi:10.1186/CC11219

Published: 20 June 2012


Although clinical trials have shown benefit from early rehabilitation within the ICU, rehabilitation of patients following critical illness is increasingly acknowledged as an area of clinical importance. However, despite recommendations from published guidelines for rehabilitation to continue following hospital discharge, there is limited evidence to underpin practice during this intermediate stage of recovery. Those patients with ICU-acquired weakness on discharge from the ICU are most likely to benefit from ongoing rehabilitation. Despite this, screening based on strength alone may fail to account for the associated level of physical functioning, which may not correlate with muscle strength, nor address non-physical complications of critical illness. The aim of this review was to consider which patients are likely to require rehabilitation following critical illness and to perform an integrative review of the available evidence of content and nature of exercise rehabilitation programmes for survivors of critical illness following hospital discharge. Literature databases and clinical trials registries were searched using appropriate terms and groups of terms. Inclusion criteria specified the reporting of rehabilitation programmes for patients following critical illness post-hospital discharge. Ten items, including data from published studies and protocols from trial registries, were included. Because of the variability in study methodology and inadequate level of detail of reported exercise prescription, at present there can be no clear recommendations for clinical practice from this review. As this area of clinical practice remains in its relative infancy, further evidence is required both to identify which patients are most likely to benefit and to determine the optimum content and format of exercise rehabilitation programmes for patients following critical illness post-hospital discharge.