Comparative effectiveness of non-pharmacological interventions on the prognosis of critically ill patients: A systematic review and network meta-analysis

Background

The prognosis of critically ill patients has received extensive attention. Multiple non-pharmacological interventions have been proposed; however, their comparative effectiveness remains uncertain.

Objective

To evaluate and compare the effectiveness of non-pharmacological interventions for critically ill patients on the incidence of intensive care unit (ICU)-acquired weakness, muscle strength, daily activities, quality of life, and physical performance.

Methods

A comprehensive search was conducted in PubMed, Embase, the Cochrane Library, Web of Science, China Biology Medicine, Chinese National Knowledge Infrastructure, and Wanfang databases from inception to August 2025 for randomized controlled trials involving adults hospitalized in the ICU for more than 48 h. Risk of bias was assessed using the with Cochrane Risk of Bias tool version 2.0 (RoB2). Network meta-analysis was performed using Stata version 16.0. The surface under the cumulative ranking curve (SUCRA) was utilized to rank intervention effectiveness. The study protocol was registered in PROSPERO (CRD42024499277).

Results

A total of 45 studies evaluating nine non-pharmacological interventions were included. Physical exercise combined with electrical stimulation, physical exercise combined with virtual reality technology, physical exercise combined with nutritional supplementation, physical exercise alone significantly reduced the incidence of ICU-acquired weakness, with odds rations (OR) and 95 % confidence intervals (CI) of 0.14 (0.09, 0.24), 0.13 (0.03, 0.54), 0.46 (0.22, 0.94) and 0.46 (0.22, 0.94), respectively. For muscle strength, light therapy showed significant improvement, with mean differences (MD) and 95 % CI of 10.42 (1.65, 19.19). Physical exercise combined with electrical stimulation and physical exercise alone effectively improved activities of daily living, with standardized mean differences (SMD) and 95 % CI of 0.83 (0.34, 1.32) and 0.51 (0.09, 0.93). Physical exercise combined with electrical stimulation also improved quality of life (SMD 0.50, 95 % CI 0.07, 0.93), and physical performance (SMD 1.09, 95 % CI 0.40, 1.77), while physical exercise alone improved physical performance (SMD 0.61, 95 % CI 0.14, 1.08). Sensitivity analysis indicated that the effects of these interventions were unstable for quality of life and physical performance.

Conclusion

Physical exercise combined with electrical stimulation appears most effective in reducing ICU-acquired weakness and enhancing daily living activities. Light therapy significantly improved muscle strength. However, the effects of these interventions on quality of life and physical performance were less stable. These findings provide valuable insights for the clinical management of critically ill patients.