Empowering recovery: A scoping review of post-ICU exercise rehabilitation success factors and challenges

Problem considered: Post-intensive care syndrome (PICS) frequently results in physical impairments, notably intensive care unit-acquired weakness (ICU-AW), affecting neuromuscular functions such as swallowing, breathing, mobility, and personal autonomy. Despite advancements, achieving comprehensive post-ICU physical recovery presents significant challenges. This necessitates a thorough understanding of physical activity patterns among survivors and the exploration of barriers and facilitators that can enhance recovery outcomes. This review aims to systematically identify and categorize these factors in the context of post-intensive care exercise-based rehabilitation. Methods: Employing Arksey and O'Malley's scoping review framework, we examined three electronic databases: MEDLINE via PubMed, Scopus, and Web of Science. The review focused on qualitative studies published in English that evaluated the barriers and facilitators affecting physical activity among survivors of critical illness. Results: The search resulted in seven qualitative studies meeting the inclusion criteria, all scoring seven to eight out of 10 criteria on the JBI checklist for qualitative research. The identified facilitators and barriers were categorized into three primary themes: patient-related, task-related, and environment-related. Patient-related factors included elements such as motivation, spirituality, concentration difficulties, and sleep disturbances. Task-related aspects were primarily related to communication and managing conflicting priorities. The environmental factors included family and peer support, transport accessibility, and financial management. Conclusion: The review highlights a range of modifiable barriers encountered by ICU survivors in their exercise-based rehabilitation following discharge, encompassing physical, social, psychological, financial, and environmental spheres. Further exploration of these elements is critical to improve patient care outcomes. Clinical significance: Understanding and mitigating barriers to postcritical care rehabilitation is essential for developing targeted, patient-centered rehabilitation strategies, facilitating more effective and rapid recovery for critical illness survivors.