Cognitive Rehabilitation Interventions in the Intensive Care Unit: A Systematic Integrative Review.

Abstract

Background: Because critical illness, sedation, and ICU treatment commonly disrupt attention, memory, and executive function, early cognitive rehabilitation during the ICU stay may preserve or restore these capacities, reduce the delirium burden, and support engagement and recovery. Our primary aim was to identify and describe cognitive rehabilitation interventions delivered during the ICU stay and describe the healthcare professionals providing them. Secondarily, we summarized patient-important outcomes associated with these interventions and appraised study quality to inform future research.

Method: We performed a systematic integrative review with searches in Medline, EMBASE, CINAHL, and CENTRAL. Eligible studies included adult ICU patients receiving or healthcare professionals delivering early cognitive rehabilitation initiated in the ICU. Data synthesis followed PRISMA guidelines, and risk of bias was assessed using RoB2 and ROBINS-I and narratively described.

Results: We included 27 studies: 10 randomized clinical trials, six cross-sectional studies, five cohort studies, three qualitative studies, three non-randomized trials, and one mixed-methods study. Four categories of interventions were identified: (1) orientation and multisensory stimulation, (2) activities of daily living (ADL)-focused functional occupational therapy, (3) early mobilization and physical rehabilitation, and (4) technology-based sensory and affective stimulation (music or virtual reality). Interventions were provided by nurses, physiotherapists, occupational therapists, research staff, and family members. Multi-component programs combining cognitive and physical elements indicated possible benefits for selected cognitive measures. Effects estimates on delirium and ADL were inconsistent and, in several studies, were based on secondary or exploratory outcomes analyses. Outcomes related to ventilator-free days, health-related quality of life, and survival were also inconsistent, with substantial heterogeneity in outcome definitions, measurement tools, and assessment time points.

Conclusion: Multi-component cognitive rehabilitation appeared clinically applicable, but effects on patient-important outcomes were uncertain. High-quality research is needed to assess whether interventions targeting the improvement of cognitive function benefit ICU patients.

Editorial comment: This systematic review presents and update of published work on cognitive rehabilitation performed during ICU care and then also with assessments after critical illness in ICU survivors. The findings support the idea that this field need more robust clinical research to assess these different interventions in the ICU and their possible benefit and cost.