Standard of care for rehabilitation in critical illness

Intensive Care Medicine: Published: 30 April 2026

Background

Rehabilitation is recognised as a cornerstone of intensive care, essential for optimising functional recovery and reducing long-term disability. Contemporary ICU populations, characterised by advanced age, multimorbidity, and prolonged stays, are at heightened risk of muscle wasting, immobility, frailty, cognitive decline, and functional dependence. Mitigation of these sequelae requires careful interprofessional collaboration for person-centred rehabilitation across the care continuum.

Content

This review synthesises evidence from randomised controlled trials, meta-analyses, and clinical practice guidelines on rehabilitation during and after intensive care. Best practice within the ICU begins with early awakening and mobilisation with evidence demonstrating that physical rehabilitation is safe, with low adverse-event rates. Furthermore, multiprofessional strategies that span across ICU, ward, and community are required to address complex problems including physical, cognitive, and psychological sequelae of critical illness.

Future directions

Research priorities include detailed reporting of intervention dose (timing, intensity, duration) for both usual care and rehabilitation provided within clinical trials, and development of intervention implementation strategies that enhance uptake and fidelity in routine practice.

Conclusion

Rehabilitation is integral to contemporary ICU care, spanning the trajectory of recovery into the community. Within the ICU, it requires interprofessional, experienced healthcare personnel to assess clinical status for safe rehabilitation and to identify an individual’s anticipated recovery trajectory. Standardised intervention reporting and implementation-focussed research are essential to advance evidence and improve outcomes for critically ill patients.

 

 

Early prediction of new-onset physical disability after intensive care unit stay

Early prediction of new-onset physical disability after intensive care unit stay: preliminary instrument. Critical Care 2014, 18: 455.

Schandl, A., et al.

http://ccforum.com/content/pdf/s13054-014-0455-7.pdf

Many intensive care unit (ICU) survivors suffer from physical disability for months after ICU 
stay. There is no structured method to identify patients at risk for such problems. The purpose 
of the study was to develop a method for early in-ICU prediction of the patient’s individual 
risk for new-onset physical disability two months after ICU stay. 

Interventions to improve the physical function of ICU survivors

Interventions to improve the physical function of ICU survivors: A systematic review. Chest, 2013, Vol. 144(5), p.1469-80.

Calvo-Ayala, E., et al.

http://journal.publications.chestnet.org/article.aspx?articleid=1727081#Abstract

ICU admissions are ever increasing across the United States. Following critical illness, physical functioning (PF) may be impaired for up to 5 years. We performed a systematic review of randomized controlled trials evaluating the efficacy of interventions targeting PF among ICU survivors. The objective of this study was to identify effective interventions that improve long-term PF in ICU survivors.

Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function.

1: JAMA. 2008 Oct 8;300(14):1685-90. LinkOut
Needham DM.
Division of Pulmonary and Critical Care Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland 21205, USA. dale.needham@jhmi.edu

Early mobilization of patients in the hospital and the intensive care unit has a strong historical precedent. However, in more recent times, deep sedation and bed rest have been part of routine medical care for many mechanically ventilated patients. A growing body of literature demonstrates that survivors of severe critical illness commonly have significant and prolonged neuromuscular complications that impair their physical function and quality of life after hospital discharge. Bed rest, and its associated mechanisms, may play an important role in the pathogenesis of neuromuscular weakness in critically ill patients. A new approach for managing mechanically ventilated patients includes reducing deep sedation and increasing rehabilitation therapy and mobilization soon after admission to the intensive care unit. Emerging research in this field provides preliminary evidence supporting the safety, feasibility, and potential benefits of early mobilization in critical care medicine.

PMID: 18840842 [PubMed - in process]