Post-hospital physical rehabilitation for physical function recovery among community-dwelling survivors of critical illness: A systematic review protocol

Introduction: Many survivors of critical illness experience lasting physical disability. Post-hospital rehabilitation has the potential to reduce this physical disability; however, primary studies have reported inconsistent results. We aimed to answer the following question: Among community-dwelling adults who survived critical illness, does participation in post-hospital physical rehabilitation, compared with no rehabilitation or alternative non-physical interventions, improve physical functioning 12 months after discharge from acute care? Materials and methods: This is a systematic review protocol that was registered with PROSPERO (CRD 420251174065). It will be conducted with Cochrane methods and reported according to the 2020 Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. To optimize the impact of this review, our study team includes a patient partner to guide our methods and interpretation. To be eligible, peer-reviewed randomized controlled trials must have enrolled community-dwelling adults (≥ 18 years) previously admitted to the ICU (≥24 hours) to a post-hospital physical rehabilitation program compared to any control. Outcomes of interest include physical function, return to work, and health care utilization. We will search five databases from their inception. Study screening, selection and extraction will be conducted independently and in duplicate using Covidence. Disagreements will be resolved through discussion or with a third reviewer. We will assess risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). Where appropriate, we will conduct meta-analyses using random-effects modeling. Certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Conclusion: A recent international multiprofessional expert panel highlighted the importance of understanding how follow-up care models can optimize long-term recovery after critical illness. Our review will provide a comprehensive synthesis of the impact of post-hospital rehabilitation on long-term recovery of survivors of critical illness.