IMPORTANCE: Evidence for remote multicomponent rehabilitation among critical care survivors is sparse.
OBJECTIVE: To investigate the effects of a 6-week, remote, multicomponent rehabilitation intervention in survivors of critical illness following discharge from the hospital after an intensive care unit (ICU) admission compared with standard care on health-related quality of life at 8 weeks.
DESIGN, SETTING, AND PARTICIPANTS: Pragmatic, multicenter, assessor-blinded, randomized clinical trial conducted from December 2022 to November 2025 at 52 National Health Service hospitals in the UK. Participants were adults who had been discharged from the hospital within the last 12 weeks with an ICU admission (required mechanical ventilation for =48 hours during ICU stay).
INTERVENTIONS: Individuals were randomized to a 6-week, remote, multicomponent, individualized, rehabilitation intervention incorporating weekly symptom management; targeted exercise; psychological support; and peer support and information commenced within 12 weeks of hospital discharge (n = 231) or standard care (n = 198).
MAIN OUTCOMES AND MEASURES: The primary outcome was health-related quality of life at 8 weeks measured by the EuroQoL 5-dimension 5-level questionnaire (EQ-5D-5L) utility score (from -0.285 [worst/worse than dead] to 1 [best health]; minimum clinically important difference: 0.08) and analyzed using linear regression (adjusted for baseline covariates). The secondary outcomes included leg strength and exercise capacity; self-reported perception of fatigue, anxiety, or depression; illness perception; acceptability of the intervention; and any adverse events.
RESULTS: Of the 3705 screened patients, 429 (12%) were randomized (mean age, 55.4 [SD, 13.9] years; 184 female [42.9%]; 245 male [57.1%]; and had median Acute Physiology and Chronic Health Evaluation II score of 18 [IQR, 14 to 22]). The mean EQ-5D-5L utility score at 8 weeks was 0.69 (SD, 0.26) in the intervention group compared with 0.67 (SD, 0.27) in the standard care group (adjusted mean difference, 0.04 [95% CI, -0.001 to 0.09]; P = .05). The intervention improved 4 of the 6 secondary outcomes, including leg strength and exercise capacity, fatigue, anxiety, and acceptability of the intervention; there was no change in perception of depression or illness. Four adverse events were related to the intervention; no serious events were attributed to the intervention.
CONCLUSIONS AND RELEVANCE: A 6-week, multicomponent, rehabilitation program did not improve health-related quality of life at 8 weeks after discharge in ICU survivors who required mechanical ventilation.
TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN11266403.
| Specialty Area | Score |
|---|---|
| Physical Medicine and Rehabilitation | |
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
| Intensivist/Critical Care |
Though it only seems practical that rehabilitation programs following ICU discharge can be beneficial, this randomized study did not show any benefit in health-related quality of life after remote multicomponent rehabilitation. Further studies to assess this can be beneficial.
A well designed and well executed MC RCT. The disappointingly marginal benefit of a formal rehabilitatitive intervention on overfall QOL most likely reflects the advancing age and comorbidities of the study population, and that half were ventilated for more than 7 days. It is not implausible that more intensive post-ICU rehabilitation might prove cost-beneficial in younger and less critically ill patients; however, since a large proportion of critically ill ICU patients requiring prolonged mechanical ventilation are elderly and have multiple comorbidities, the cost-benefit of a formal comprehensive rehabilitation program for all ICU survivors, beyond PT and OT, is questionable.
Patients discharged from ICU stays have poorer health. This trial examined whether virtual vs. usual care would improve quality of life and function. Unfortunately, the trial was negative. Recovering from an ICU stay involves significant amounts of depression and neurologic injury; someone often needs a reason to fight on. I do not believe any virtual framework will be as good as something in-person in this regard, and this trial bears that out.
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