Effectiveness of rehabilitation interventions in adults with multi-organ dysfunction syndrome: A rapid review.
Chiara Arienti, Stefano G Lazzarini, Elisa Pollini and 3 others
PMID 34037239WHAT IT FOUND
Neuromuscular electrical stimulation (NMES) showed mixed results in critically ill adults with multi-organ dysfunction.
While some studies reported preserved muscle mass and strength, others found no functional difference compared to standard care. The evidence is very low certainty due to small sample sizes and high risk of bias.
Key findings
01NMES reduced muscle mass loss and improved muscle strength in two of the three included randomized controlled trials.
02In the largest trial, adding NMES and whole-body vibration to early physiotherapy did not result in significant differences in muscle strength or functional mobility at ICU discharge compared to physiotherapy alone.
03The overall quality of evidence was rated as low due to high risk of bias, small numbers of studies, and imprecision.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The review included only three studies with a small total sample size of 90 participants, leading to imprecision. There was a high risk of bias in the included studies, particularly regarding blinding of participants and personnel, which is difficult in physical interventions. The definition of MODS and the specific rehabilitation protocols varied across studies, making direct comparison difficult. The largest study (Wollersheim) added NMES to an already intensive early physiotherapy protocol, which may have masked additional benefits compared to a less active control group.
Declared interests
The authors have no conflicts of interest to declare.
The easy way to misread this
Do not interpret the positive findings in the smaller studies as proof of efficacy. The largest trial showed no benefit of NMES over standard early physiotherapy, and the overall certainty of evidence is very low. Clinical decisions should not rely solely on this review.