Systematic review and meta-analysis of physical rehabilitation on functional recovery in critically ill patients
In brief
Physical rehab cuts ICU-acquired weakness risk by 38% and trims ventilator time
A meta-analysis of 40 trials in 5,135 critically ill adults found that early physical rehabilitation modestly increased muscle strength, lowered the odds of ICU-acquired weakness by about a third, and reduced mechanical ventilation by roughly 1.3 days and ICU stay by 1.4 days, without affecting mortality. The findings support routine rehab but leave the optimal protocol uncertain.
- Journal
- Frontiers in medicine (Q1)
- Published
- 18 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Gang Wang, Xinghua Li, Linlin Fan, Li Lin, Zhiguo Yu, Qing Fang, et al.
- PMID
- 42682648
- DOI
- 10.3389/fmed.2026.1877465
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 6 September 2026): Systematic review of physical rehab in critically ill adults
- Picked for Epidemiology (top studies of the week, 6 September 2026): Systematic review/meta‑analysis of RCTs, not observational epidemiology
Abstract
PURPOSE: Survivors of critical illness frequently experience persistent physical impairment, particularly ICU-acquired weakness (ICU-AW), which contributes to prolonged disability after intensive care. We conducted a systematic review and meta-analysis to evaluate the effects of physical rehabilitation on muscle strength, physical function, health-related quality of life, and clinical outcomes in critically ill adults. METHODS: Four electronic databases were searched from inception to March 2026. Randomized controlled trials (RCTs) comparing physical rehabilitation with usual rehabilitation in adult critically ill patients were included. The primary outcome was muscle strength assessed by the Medical Research Council (MRC) sum score. Secondary outcomes included ICU-AW, physical function, health-related quality of life, duration of mechanical ventilation (MV), mortality, and ICU and hospital length of stay. RESULTS: Forty RCTs involving 5,135 patients (2,554 physical rehabilitation; 2,581 usual rehabilitation) were included. Physical rehabilitation was associated with improved MRC sum score (SMD 0.26, 95% CI 0.05-0.46; p = 0.02; I 2 = 70%), reduced incidence of ICU-AW (OR 0.62, 95% CI 0.43-0.87; p = 0.007; I 2 = 34%), improved Barthel Index (SMD 0.62, 95% CI 0.21-1.03; p = 0.003; I 2 = 85%) and SF-36 physical function (SMD 0.53, 95% CI 0.26-0.81; p < 0.001; I 2 = 81%), shortened duration of MV (MD -1.32 days, 95% CI -1.98 to -0.65; p < 0.001; I 2 = 66%) and ICU length of stay (MD -1.41 days, 95% CI -2.03 to -0.78; p < 0.001; I 2 = 44%), but had no significant effects on mortality or hospital length of stay. CONCLUSION: Physical rehabilitation is associated with improved muscle strength and functional recovery, reduced ICU-AW, and shorter mechanical ventilation duration and ICU stay, but not reduced mortality. Further high-quality Multicenter trials are needed to define the optimal rehabilitation strategy. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023462649, Identifier CRD42023462649.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.