Weakness and rehabilitation after discharge in post-intensive care syndrome: A narrative review
DOI:
https://doi.org/10.62827/fb.v27i9.1324Keywords:
Activities of Daily Living; Patient Discharge; Exercise Therapy; Quality of Life.Abstract
Introduction: Post-intensive care syndrome may combine muscle weakness, limitations in daily activities, and cognitive or emotional problems that persist after discharge. Objective: To examine the relationship between intensive care unit-acquired weakness, functional decline, and rehabilitation outcomes from intensive care discharge through the period after hospital discharge. Methods: Narrative review of adult studies identified in PubMed searches conducted in September and updated in October 2026 using subject headings and free-text terms, and in the Scientific Electronic Library Online using Portuguese and English free-text terms for post-intensive care syndrome, weakness, function, and rehabilitation; earlier studies on syndrome definition, weakness diagnosis, functional trajectories, and rehabilitation interventions were also examined. Results: Weakness is associated with poorer performance and dependence, but strength, mobility, functional independence, and quality of life follow different trajectories. Trials after discharge show heterogeneous findings. In a recent multicenter trial, remote intervention improved some secondary outcomes but not the primary quality-of-life outcome at eight weeks; a secondary analysis suggested a difference at six months. Conclusion: As a clinical implication supported by guidelines, repeated functional assessment and rehabilitation directed at specific limitations are appropriate, whereas the benefit of intensified programs for all survivors remains uncertain.
References
Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med. 2012;40(2):502-9. doi:10.1097/CCM.0b013e318232da75
Renner C, Jeitziner MM, Albert M, Brinkmann S, Diserens K, Dzialowski I, et al. Guideline on multimodal rehabilitation for patients with post-intensive care syndrome. Crit Care. 2023;27(1):301. doi:10.1186/s13054-023-04569-5
Latronico N, Rasulo FA, Eikermann M, Piva S. Critical Illness Weakness, Polyneuropathy and Myopathy: Diagnosis, treatment, and long-term outcomes. Crit Care. 2023;27(1):439. doi:10.1186/s13054-023-04676-3
Fan E, Cheek F, Chlan L, Gosselink R, Hart N, Herridge MS, et al. An official American Thoracic Society Clinical Practice guideline: the diagnosis of intensive care unit-acquired weakness in adults. Am J Respir Crit Care Med. 2014;190(12):1437-46. doi:10.1164/rccm.201411-2011ST
Eggmann S, Luder G, Verra ML, Irincheeva I, Bastiaenen CHG, Jakob SM. Functional ability and quality of life in critical illness survivors with intensive care unit acquired weakness: A secondary analysis of a randomised controlled trial. PLoS One. 2020;15(3):e0229725. doi:10.1371/journal.pone.0229725
Hodgson CL, Udy AA, Bailey M, Barrett J, Bellomo R, Bucknall T, et al. The impact of disability in survivors of critical illness. Intensive Care Med. 2017;43(7):992-1001. doi:10.1007/s00134-017-4830-0
Wieske L, Dettling-Ihnenfeldt DS, Verhamme C, Nollet F, van Schaik IN, Schultz MJ, et al. Impact of ICU-acquired weakness on post-ICU physical functioning: a follow-up study. Crit Care. 2015;19(1):196. doi:10.1186/s13054-015-0937-2
Schmidt D, Margarites AG, Alvarenga LPKB, Paesi PM, Friedman G, Sbruzzi G. Post-COVID-19 Intensive Care Unit-Acquired Weakness Compromises Long-Term Functional Status. Phys Ther. 2023;103(12):pzad117. doi:10.1093/ptj/pzad117
Gandotra S, Lovato J, Case D, Bakhru RN, Gibbs K, Berry M, et al. Physical Function Trajectories in Survivors of Acute Respiratory Failure. Ann Am Thorac Soc. 2019;16(4):471-477. doi:10.1513/AnnalsATS.201806-375OC
Nakanishi N, Liu K, Kawauchi A, Okamura M, Tanaka K, Katayama S, et al. Instruments to assess post-intensive care syndrome assessment: a scoping review and modified Delphi method study. Crit Care. 2023;27(1):430. doi:10.1186/s13054-023-04681-6
du Plessis I, Hanekom SD, Lupton-Smith AR. Physical function measures in ICU survivors, where to now? A scoping review. South Afr J Crit Care. 2024;40(2):e1742. doi:10.7196/SAJCC.2024.v40i2.1742
Walsh TS, Salisbury LG, Merriweather JL, Boyd JA, Griffith DM, Huby G, et al. Increased hospital-based physical rehabilitation and information provision after intensive care unit discharge: the RECOVER randomized clinical trial. JAMA Intern Med. 2015;175(6):901-10. doi:10.1001/jamainternmed.2015.0822
Denehy L, Skinner EH, Edbrooke L, Haines K, Warrillow S, Hawthorne G, et al. Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months of follow-up. Crit Care. 2013;17(4):R156. doi:10.1186/cc12835
McWilliams DJ, Benington S, Atkinson D. Outpatient-based physical rehabilitation for survivors of prolonged critical illness: a randomized controlled trial. Physiother Theory Pract. 2016;32(3):179-90. doi:10.3109/09593985.2015.1137663
Battle C, James K, Temblett P, Hutchings H. Supervised exercise rehabilitation in survivors of critical illness: a randomised controlled trial. J Intensive Care Soc. 2019;20(1):18-26. doi:10.1177/1751143718767061
Major ME, Dettling-Ihnenfeldt D, Ramaekers SPJ, Engelbert RHH, van der Schaaf M. Feasibility of a home-based interdisciplinary rehabilitation program for patients with Post-Intensive Care Syndrome: the REACH study. Crit Care. 2021;25(1):279. doi:10.1186/s13054-021-03709-z
Taito S, Yamauchi K, Tsujimoto Y, Banno M, Tsujimoto H, Kataoka Y. Does enhanced physical rehabilitation following intensive care unit discharge improve outcomes in patients who received mechanical ventilation? A systematic review and meta-analysis. BMJ Open. 2019;9(6):e026075. doi:10.1136/bmjopen-2018-026075
Cazeta BBR, de Queiroz RS, Nacimento TS, Ferreira BR, Saquetto MB, Martinez BP, et al. Effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness: A systematic review and meta-analysis of randomized trials. Clin Rehabil. 2024;38(7):898-909. doi:10.1177/02692155241241665
Shimizu M, Yoshihiro S, Watanabe S, Aikawa G, Fujinami Y, Kawamura Y, et al. Efficacy of Enhanced Rehabilitation Initiated After Hospital Discharge to Improve Quality of Life in Survivors of Critical Care: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cureus. 2024;16(12):e75184. doi:10.7759/cureus.75184
O'Neill B, Bradley JM, Connolly B, Bruce J, Ratna M, Lall R, et al. Remote Multicomponent Rehabilitation in Intensive Care Unit Survivors: A Randomized Clinical Trial. JAMA. 2026;336(3):236-247. doi:10.1001/jama.2026.7401
Nakanishi N, Liu K, Hatakeyama J, Kawauchi A, Yoshida M, Sumita H, et al. Post-intensive care syndrome follow-up system after hospital discharge: a narrative review. J Intensive Care. 2024;12(1):2. doi:10.1186/s40560-023-00716-w
Khan SH, Perkins AJ, Unverzagt FW, Wang S, Moser LR, Moiz S, et al. Improving Recovery and Outcomes Every Day After the ICU (IMPROVE): A Randomized Controlled Trial. Crit Care Med. 2025;53(8):e1542-e1553. doi:10.1097/CCM.0000000000006698
Smith JM, Lee AC, Zeleznik H, Coffey Scott JP, Fatima A, Needham DM, et al. Home and Community-Based Physical Therapist Management of Adults With Post-Intensive Care Syndrome. Phys Ther. 2020;100(7):1062-1073. doi:10.1093/ptj/pzaa059
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Rafael Viana dos Santos Coutinho, Benara Otoni de Siqueira, Nayara Grobério de Paula, Laura Santos Firme, Italo Damião de Sousa Gontijo (Autor)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Autores que publicam nesta revista concordam com os seguintes termos:
Autores mantém os direitos autorais e concedem à revista o direito de primeira publicação, com o trabalho simultaneamente licenciado sob a Licença Creative Commons Attribution 4.0 que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista.
Autores têm autorização para distribuição não-exclusiva da versão do trabalho publicada nesta revista (ex.: publicar em repositório institucional ou como capítulo de livro), com reconhecimento de autoria e publicação inicial nesta revista.
