Responsiveness of Critically Ill Adults with Multimorbidity to Rehabilitation Interventions: A Patient Level Meta-analysis using Individual Pooled Data from Four Randomized Trials

Jennifer Jones*, Amalia Karahalios, Zudin Puthucheary, Michael J Berry, D Clark Files, David M Griffith, Luke A McDonald, Peter Morris, Marc Moss, Amy Nordon-Craft, Tim Walsh, Sue Berney, Linda Denehy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Objective To explore if patient characteristics (pre-existing comorbidity, age, sex and illness severity) modify the effect of physical rehabilitation (intervention vs control) for the co-primary outcomes health-related quality of life (HRQoL) and objective physical performance using pooled individual patient data from randomized controlled trials.
Data Sources Data of individual patients from four critical care physical rehabilitation randomised controlled trials.
Study Selection Eligible trials were identified from a published systematic review.
Data Extraction 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 analysed with linear mixed models fitted with fixed effects for treatment group, time and trial.
Data Synthesis 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 three and six months compared to the similarly comorbid control group (based on the Physical Component Summary (PCS) score (Wald test p=0.041)). Patients with one or no comorbidities who received intervention had no HRQoL outcome differences at three and six months when compared to similarly comorbid control patients. No patient characteristic modified the physical performance outcome in patients who received physical rehabilitation.
Conclusions The identification of a target group with two or more comorbidities who derived benefit 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.
Registration: PROSPERO (CRD42019152526).
Original languageEnglish
JournalCritical Care Medicine
DOIs
Publication statusPublished - 29 May 2023

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