Preventing ICU ‐Acquired Weakness With Early Rehabilitation: An Umbrella Review of Systematic Reviews and Meta‐Analysis

BACKGROUND: Intensive care unit-acquired weakness (ICU-AW) causes prolonged hospitalisations and higher mortality. Systematic reviews and meta-analyses (SR/MA) regarding ICU-AW and early rehabilitation need a synthesis of the existing evidence. AIM: The aim of this study was to summarise findings from several SR/MA to provide an overview of early rehabilitation as a means to prevent ICU-AW. STUDY DESIGN: This was an umbrella review of SR/MA. Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Joanna Briggs Institute guidelines were used for the process. MEDLINE, Embase, Cochrane Database of Systematic Reviews and Airiti Library were searched for keywords. A search was conducted for papers published from the inception of the databases up to January 2025. Neither language nor publication year was restricted. A meta-analyses would be conducted if there were inconsistencies in the current SR/MA. RESULTS: An analysis of seven SRs with a quality above medium was conducted. Sixty-nine primary studies from seven SRs discussed early rehabilitation in preventing ICU-AW. According to meta-analyses, early rehabilitation can significantly reduce the incidence of ICU-AW, with a risk difference of -0.10 (95% CI: -0.18 to -0.03, z = 2.580, p = 0.010). Subgroup analysis further revealed that initiating rehabilitation within 1-3 days of ICU admission was associated with a 13% lower risk of ICU-AW (RD: -0.13; 95% CI: -0.22 to -0.04; z = 2.92; p = 0.003). Other subgroup analyses showed no statistically significant differences. The type of early rehabilitation that was most effective could not be determined due to the variability in interventions and outcomes. CONCLUSIONS: Early rehabilitation could significantly prevent ICU-AW incidence. The meta-analysis indicated that the early rehabilitation group has a 10% lower ICU-AW incidence risk. RELEVANCE TO CLINICAL PRACTICE: Providing early rehabilitation should be a nursing priority in the ICU in order to prevent ICU-AW and enhance patient recovery.