Rehabilitation in the Intensive Care Unit for Adults with Traumatic Brain Injury: A Systematic Review and...

Area of Science:

• Neurology
• Intensive Care Medicine
• Rehabilitation Medicine

Background:

• Traumatic brain injury (TBI) is a significant global cause of disability.
• Intensive care unit (ICU) rehabilitation is recommended for critically ill patients.
• The safety and efficacy of physical rehabilitation for adult TBI patients in the ICU remain unclear.

Purpose of the Study:

• To assess the safety of physical ICU rehabilitation in adult TBI patients.
• To evaluate the impact of ICU rehabilitation on physical outcomes and length of ICU stay.

Main Methods:

• A systematic review and meta-analysis of studies on physical ICU rehabilitation for acute TBI in adults.
• Searched five electronic databases up to September 1, 2025.
• Narrative synthesis for safety outcomes and random-effects meta-analysis for secondary outcomes.
• Risk of bias assessed using ROBINS-E and RoB2 tools.

Main Results:

• Included 13 studies with 3582 adult TBI patients.
• Four studies reported safety outcomes, showing no or low adverse event rates.
• Meta-analysis indicated improved Perme ICU Mobility Scores at ICU discharge with rehabilitation (MD 3.25, p<0.00001).
• High risk of bias was noted in observational studies, with some concerns in randomized studies.

Conclusions:

• Physical rehabilitation in the ICU for adults with TBI is potentially safe.
• ICU rehabilitation may offer benefits for mobility status upon ICU discharge.
• High-quality studies are necessary to further investigate ICU rehabilitation for TBI patients.