Responsiveness of Critically Ill Adults With Multimorbidity to Rehabilitation Interventions: A Patient-Level Meta-Analysis Using Individual Pooled Data From Four Randomized Trials.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 10 2023
01 10 2023
Historique:
medline:
15
9
2023
pubmed:
29
5
2023
entrez:
29
5
2023
Statut:
ppublish
Résumé
To explore if patient characteristics (pre-existing comorbidity, age, sex, and illness severity) modify the effect of physical rehabilitation (intervention vs control) for the coprimary outcomes health-related quality of life (HRQoL) and objective physical performance using pooled individual patient data from randomized controlled trials (RCTs). Data of individual patients from four critical care physical rehabilitation RCTs. Eligible trials were identified from a published systematic review. Data sharing agreements were executed permitting transfer of anonymized data of individual patients from four trials to form one large, combined dataset. The pooled trial data were analyzed with linear mixed models fitted with fixed effects for treatment group, time, and trial. Four trials contributed data resulting in a combined total of 810 patients (intervention n = 403, control n = 407). After receiving trial rehabilitation interventions, patients with two or more comorbidities had HRQoL scores that were significantly higher and exceeded the minimal important difference at 3 and 6 months compared with the similarly comorbid control group (based on the Physical Component Summary score (Wald test p = 0.041). Patients with one or no comorbidities who received intervention had no HRQoL outcome differences at 3 and 6 months when compared with similarly comorbid control patients. No patient characteristic modified the physical performance outcome in patients who received physical rehabilitation. The identification of a target group with two or more comorbidities who derived benefits from the trial interventions is an important finding and provides direction for future investigations into the effect of rehabilitation. The multimorbid post-ICU population may be a select population for future prospective investigations into the effect of physical rehabilitation.
Identifiants
pubmed: 37246922
doi: 10.1097/CCM.0000000000005936
pii: 00003246-990000000-00159
doi:
Types de publication
Meta-Analysis
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1373-1385Subventions
Organisme : NINR NIH HHS
ID : R01 NR011051
Pays : United States
Organisme : NHLBI NIH HHS
ID : K24 HL089223
Pays : United States
Organisme : Chief Scientist Office
ID : CZH/4/531
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
Dr. Puthucheary reports honorarium and speaker fees from Baxter, Faraday Pharmaceuticals, Lyric Pharmaceuticals, Fresenius-Kabi, Nestle, Orion, GlaxoSmithKline, and Nutritica. Dr. Files reports consulting fees from Cytovale. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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