What are the factors that impact on physical activity and rehabilitation for survivors of critical illness: a systematic review of quantitative and qualitative studies

Selina Parry, Laura Knight, Bronwen Connolly, Claire Baldwin, Zudin Puthucheary, Linda Denehy, Nicholas Hart, Peter Morris, Jessica Mortimore, Catherine Granger

Research output: Contribution to conferencePaperpeer-review


Introduction: Physical activity / rehabilitation forms a pivotal aspect
of recovery after critical illness and studies have demonstrated it is
safe, feasible and potentially efficacious at improving patient outcomes
[1,2]. However, international data demonstrate low levels of
mobilisation occur in the ICU[3,4]. A current gap exists between the
perceived need and actual practice of implementing physical activity
across the recovery continuum.
Objectives: To identify, evaluate and synthesise studies examining
the barriers and enablers for patients with critical illness to participate
in physical activity from the perspective of healthcare providers,
patients and caregivers.
Methods: Systematic review of articles using electronic databases:
MEDLINE, CINAHL, EMBASE, Scopus and Cochrane. Quantitative and
qualitative studies which assessed the barriers, or enablers to physical
activity for patients with critical illness were included. Registered
on PROSPERO (number: CRD42016035454).
Results: 79 studies were included. Studies included primarily ICU
survivors (69 %, n = 54 studies), healthcare providers (29 %, n = 23
studies) with only one study specifically examining caregivers and
patients. Barriers and enablers to physical activity were identified (5
major themes and 28 sub-themes). Patient-level barriers included
physical capability (physiological stability, illness severity, sedation,
weakness, delirium), psychological influences (fear/motivation) and perceived
relevance. Healthcare provider barriers included lack of time/
knowledge and expertise, communication, and concern for line safety.
Environmental barriers included lack of resources (staffing and
equipment), lower prioritisation, and lack of an established rehabilitation
pathway post ICU. Enablers included: presence of mobility teams/
protocols, designated discipline and overall leaders, teamwork and
development of daily care plans.
Conclusions: This systematic review has identified the volume of literature
demonstrating that barriers and enablers to physical activity are
multi-dimensional and span diverse factors. These factors need to be
considered when developing rehabilitation interventions to facilitate cultural
change in rehabilitation practices across the recovery continuum.
Original languageEnglish
Publication statusPublished - 2016
Externally publishedYes
Duration: 1 Jan 2016 → …


Period1/01/16 → …

Bibliographical note

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