Systematic review and meta-analysis of physical rehabilitation on functional recovery in critically ill patients.

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.