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Table 3 Summary of findings and GRADE assessment for priority outcomes

From: Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis

Outcomes

Anticipated absolute effects (95% CI)

Relative effect (95% CI)

No. of participants (studies)

Certainty of the evidence (GRADE)

Comments

Late mobilization or standard early mobilization

Systematic early mobilization

MRC Sum Score (MRC-SS), measured at ICU discharge

(i) Systematic early vs. late mobilization

–

104 (1 RCT)

⨁⨁◯◯ LOWa,b

 

The median MRC-SS in the comparator group was 48 (0 to 58)

The median MRC-SS in the intervention group was 52 (25 to 58)

(ii) Systematic early vs. standard early mobilization

–

203 (4 RCTs)

⨁◯◯◯ VERY LOWa,c,d

In a sensitivity analysis, omitting the study by Dantas et al. due to a high baseline imbalance in MRC-SS resulted in an MRC-SS in the intervention group, which was 2.2 higher (2.5 lower to 6.9 higher). For that result, the certainty of evidence is judged low (no serious inconsistency)

The mean MRC-SS in the comparator group in studies ranged from 40.3 to 47.3

The mean MRC-SS in the intervention group was 5.8 higher (1.4 lower to 13.0 higher)

Patients developing ICUAW, measured at hospital discharge

(i) Systematic early vs. late mobilization

RR 0.62 (0.38–1.03)

104 (1 RCT)

⨁⨁◯◯ LOWa,b

 

49 per 100

31 per 100

(ii) Systematic early vs. standard early mobilization

RR 0.90 (0.63–1.27)

395 (3 RCTs)

⨁◯◯◯ VERY LOWc,e

 

39 per 100

36 per 100

6-min Walk Test (6MWT), measured at various time points

(ii) Systematic early vs. standard early mobilization*

–

232 (2 RCTs)

⨁⨁◯◯ LOWa,f,g

 

The mean 6MWT distance in the comparator group was 246 m in Eggmann et al. and 267 m in Denehy et al. at hospital discharge

The mean 6MWT distance in the intervention group was 223 in Eggmann et al. and 244.2 in Denehy et al. at hospital discharge

The mean change in 6MWT from baseline in the comparator group was 184.3 m at 3 months and 219.5 m at 6 months after hospital discharge in Denehy et al

The mean change in 6MWT from baseline in the intervention group was 63.7 m higher (14.2 to 113.2) at 3 months and 72.6 m higher (9.3 to 135.8) at 6 months in Denehy et al

Time to walking, measured during hospital stay

(i) Systematic early vs. late mobilization

–

104 (1 RCT)

⨁⨁◯◯ LOWa,b

 

The median time to walking in the comparator group was 7.3 days (4.9 to 9.6)

The median time to walking in the intervention group was 3.8 days (1.9 to 5.8)

(ii) Systematic early vs. standard early mobilization

–

53 (2 RCTs)

⨁◯◯◯ VERY LOWa,c,h

 

The median time to walking in the comparator group was 6 days in Hodgson et al. and 23 days in Eggmann et al

The median time to walking in the intervention group was 6 days in Hodgson et al. and 8 days in Eggmann et al

Patients returning to independence from assistance, measured at hospital discharge

(i) Systematic early vs. late mobilization*

RR 1.71 (1.11–2.64)

104 (1 RCT)

⨁⨁◯◯ LOWa,b

 

35 per 100

59 per 100

SF-36 Physical Function Domain Score (PFS), measured 6 months after hospital discharge

(i) Systematic early vs. late mobilization

–

161 (1 RCT)

⨁◯◯◯ VERY LOWa,b,c

 

The mean SF-36 PFS in the comparator group was 43.6

The mean SF-36 PFS in the intervention group was 12.3 higher (3.9 to 20.8)

(ii) Systematic early vs. standard early mobilization

–

126 (2 RCTs)

⨁◯◯◯ VERY LOWa,c,d,e

 

The mean SF-36 PFS in the comparator group in studies ranged from 42.4 to 75.0

The mean SF-36 PFS in the intervention group was 8.1 higher (15.3 lower to 31.4 higher)

SF-36 Physical Health Component Summary Score (PCS), measured 6 months after hospital discharge

(i) Systematic early vs. late mobilization

–

161 (1 RCT)

⨁◯◯◯ VERY LOWa,b,c

 

The mean SF-36 PCS in the comparator group was 33.5

The mean SF-36 PCS in the intervention group was 3.4 higher (0.01 higher to 6.8 higher)

(ii) Systematic early vs. standard early mobilization

–

152 (2 RCTs)

⨁◯◯◯ VERY LOWc,e

 

The mean SF-36 PCS in the comparator group in studies ranged from 42.7 to 44.4

The mean SF-36 PCS in the intervention group was 2.4 lower (6.1 lower to 1.3 higher)

  1. CI confidence interval, GRADE Grading of Recommendations Assessment, Development, and Evaluation, ICU intensive care unit, ICUAW ICU-acquired weakness, MD mean difference, MRC-SS Medical Research Council Sum Score, PCS Physical Health Component Summary Score, PFS Physical Function Domain Score, RCT randomized controlled trial, RR risk ratio, 6MWT 6-min walk test
  2. *Information was available only for one comparator group
  3. aDowngraded one point due to imprecision (defined as wide confidence intervals including no effect and/or low overall sample size (defined as < 400 participants for continuous outcomes or below optimal information size for dichotomous outcomes))
  4. bDowngraded one point due to only one study contributing to outcome
  5. cDowngraded one point as majority of studies judged as of overall poor quality regarding risk of bias
  6. dDowngraded one point due to presence of substantial unexplained heterogeneity
  7. eDowngraded two points due to high imprecision [wide confidence intervals for absolute effects including important harm and low overall sample size (see definition above)]
  8. fNot downgraded as we judged the risk of bias of studies contributing data as not relevant for outcome
  9. gDowngraded one point due to only one study contributing to outcome (change from baseline deemed most important aspect of outcome)
  10. hDowngraded one point due to only one study contributing to outcome [the second study barely contributed data (n = 3)]
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Critical Care

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