Effect of Home Care on Physical Function in Post-Intensive Care Unit Patients: A Meta-Analysis

A decline in physical function is commonly observed after patients transition to their homes following hospital admission; this is especially true for patients requiring mechanical ventilation in an intensive care unit (ICU).

This meta-analysis examines characteristics and effects of home-based or outpatient+home-based interventions used to improve physical function post-discharge in patients who received mechanical ventilation in an ICU.

PRISMA guidelines were utilized. The literature search was conducted with the assistance of a medical librarian. Study inclusion criteria were post-ICU adult patients receiving mechanical ventilation who then had home-based or outpatient+home-based care to improve physical function after discharge. Effect size (Hedges' g) was calculated with random effects models.

Our search yielded 11 studies that met the inclusion criteria. The majority were randomized controlled trials, with 1 quasi-experimental study. All studies included physical therapists, and 2 included nurses. The 11 studies reported results for 39 physical function measurements. The overall pooled intervention effect across the 4 studies that utilized the 6-minute walk test was 0.32 (95% confidence intervals [CI]: 0.05 to 0.58), for the 3 studies that utilized the Timed Up and Go test it was 1.38 (95% CI: -0.09 to 2.84), and for the 8 studies that used the SF-36 Physical Function subscale, it was 0.31 (95% CI: 0.09 to 0.52).

This review's findings show that patients may improve their physical function after participating in specific intervention programs that are home-based alone or outpatient+home-based care. However, the effect sizes are small, so it may be useful to explore how to maximize the gains in physical function.