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

Neuromuscular weakness due to critical illness myopathy and polyneuropathy is a common and disabling complication of modern intensive care, contributing to prolonged ventilator dependence, delayed recovery, and persistent functional impairment among ICU survivors. With improving survival from critical illness - particularly in low- and middle-income countries - the burden of ICU-acquired weakness has increased, while rehabilitation practices remain heterogeneous and inconsistently implemented. This narrative review, developed in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) criteria, synthesises contemporary evidence on rehabilitation strategies for ICU-acquired neuromuscular weakness using a structured, non-systematic search of major databases covering publications from January 1980 to January 2025. Current evidence suggests that structured, multidisciplinary rehabilitation improves short-term muscle strength, mobility, and healthcare efficiency, although consistent benefits on mortality and long-term quality of life have not been demonstrated. Early active mobilisation increases activity levels and attainment of functional milestones but requires individualisation to ensure safety and effectiveness. Adjunctive modalities such as neuromuscular electrical stimulation and inspiratory muscle training show benefit in selected patients, particularly when integrated with conventional physiotherapy, whereas passive interventions predominantly appear insufficient when used in isolation. Diagnostic and prognostic assessment should prioritise early identification of clinically relevant weakness to enable timely rehabilitation rather than exhaustive neuromuscular classification. This review integrates key pathophysiological mechanisms, pragmatic diagnostic approaches, evidence-based rehabilitation modalities, and real-world barriers to implementation. Rehabilitation in ICU-acquired neuromuscular weakness should be regarded as a core therapeutic intervention - initiated early when feasible, titrated to illness severity, and integrated across the ICU-to-recovery continuum - to optimise outcomes for survivors of critical illness.