Rehabilitation in ICU-Acquired Weakness: An Evidence-Based Narrative Review.

Area of Science:

• Intensive Care Medicine
• Neurology
• Rehabilitation Medicine

Background:

• Critical illness myopathy and polyneuropathy cause significant neuromuscular weakness in ICU survivors.
• This weakness leads to prolonged ventilator dependence, delayed recovery, and lasting functional impairment.
• The increasing survival rates from critical illnesses amplify the burden of ICU-acquired weakness.

Purpose of the Study:

• To synthesize current evidence on rehabilitation strategies for ICU-acquired neuromuscular weakness.
• To review diagnostic approaches and implementation barriers for rehabilitation.
• To provide an evidence-based framework for managing ICU-acquired neuromuscular weakness.

Main Methods:

• A narrative review of contemporary evidence published between January 1980 and January 2025.
• A structured, non-systematic search of major scientific databases.
• Adherence to the Scale for the Assessment of Narrative Review Articles (SANRA) criteria.

Main Results:

• Structured, multidisciplinary rehabilitation enhances short-term muscle strength, mobility, and healthcare efficiency.
• Early active mobilization improves activity levels and functional milestones but needs individualization.
• Adjunctive therapies like neuromuscular electrical stimulation and inspiratory muscle training show promise when combined with physiotherapy.

Conclusions:

• Rehabilitation should be a core therapeutic intervention for ICU-acquired neuromuscular weakness.
• Early initiation, tailored intensity, and continuous integration across the care continuum are crucial.
• Prioritizing early identification of weakness for timely intervention is essential for optimizing survivor outcomes.