Factors influencing physical activity and rehabilitation in survivors of critical illness: a systematic review of quantitative and qualitative studies
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To identify, evaluate and synthesise studies examining the barriers and enablers for survivors of critical illness to participate in physical activity in the ICU and post-ICU settings from the perspective of patients, caregivers and healthcare providers.
Systematic review of articles using five electronic databases: MEDLINE, CINAHL, EMBASE, Cochrane Library, Scopus. Quantitative and qualitative studies that were published in English in a peer-reviewed journal and assessed barriers or enablers for survivors of critical illness to perform physical activity were included. Prospero ID: CRD42016035454.
Eighty-nine papers were included. Five major themes and 28 sub-themes were identified, encompassing: (1) patient physical and psychological capability to perform physical activity, including delirium, sedation, illness severity, comorbidities, weakness, anxiety, confidence and motivation; (2) safety influences, including physiological stability and concern for lines, e.g. risk of dislodgement; (3) culture and team influences, including leadership, interprofessional communication, administrative buy-in, clinician expertise and knowledge; (4) motivation and beliefs regarding the benefits/risks; and (5) environmental influences, including funding, access to rehabilitation programs, staffing and equipment.
The main barriers identified were patient physical and psychological capability to perform physical activity, safety concerns, lack of leadership and ICU culture of mobility, lack of interprofessional communication, expertise and knowledge, and lack of staffing/equipment and funding to provide rehabilitation programs. Barriers and enablers are multidimensional and span diverse factors. The majority of these barriers are modifiable and can be targeted in future clinical practice.
KeywordsCritical care Rehabilitation Physical therapy Review Behaviour change Physical activity
Awakening and breathing coordination, delirium monitoring and management, early mobility
Capability, opportunity, motivation behavioural change wheel
Consolidated criteria for reporting qualitative studies
Extracorporeal membrane oxygenation
Enhancing transparency in reporting the synthesis of qualitative research
Intensive care unit
Intensive care unit acquired weakness
Newcastle Ottawa scale
Preferred reporting items for systematic reviews and meta-analyses
Authors contribution statement
All authors contributed to the acquisition, analysis and interpretation of data and were involved in the critical revision of the manuscript for important intellectual content. SP and CG contributed to study concept and design. SP, CG, PM, ZP, CB and BC drafted the manuscript. SP is funded by a National Health and Medical Research Council (NHMRC) Early Career Fellowship and was a recipient of a short-term European Respiratory Society (ERS) travelling fellowship. CG is partially funded by a NHMRC Translating Research into Practice Fellowship co-funded by Cancer Australia. BC is funded by a National Institute of Health Research (NIHR) Postdoctoral Fellowship. BC and NH are supported by the NIHR Biomedical Research Centre based at Guy’s and St. Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of BC and NH and are not necessarily those of the NHS, the NIHR or the Department of Health.
Compliance with ethical standards
Conflicts of interest
The authors have no other formal conflicts of interest to declare.
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