Impact of early goal-directed mobilization on ICU-acquired weakness: a meta-analysis
- 1School of Basic Medical Sciences & School of Nursing, Chengdu University , , ,
- 2Department of Interventional Radiology, Deyang People’s Hospital , , ,
- 3Department of Urology, Deyang People’s Hospital , , ,
Abstract
Background: ICU-acquired weakness (ICU-AW) significantly impairs muscle strength and physical function in critically ill patients. Early mobilization interventions have been increasingly adopted, yet the specific effects of a structured EGDM program on ICU-AW and functional outcomes have not been systematically quantified. This meta-analysis aimed to evaluate the effects of EGDM on ICU-AW, muscle strength, and functional outcomes.
Methods: PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Viper Information Products (VIP) databases were searched for randomized controlled trials (RCTs) up to November 30, 2025. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2.0. RevMan 5.4 was used for meta-analysis. Subgroup analysis was prespecified by allocation concealment.
Results: Nine RCTs (907 patients) were included. EGDM reduced ICU-AW [ RR = 0.57, 95% CI (0.33 ~ 0.97), p = 0.04 for the overall effect ; I ² = 77% , p = 0.002 for heterogeneity], but sensitivity analysis of high-quality trials showed no significant effect [ RR = 0.84, 95% CI (0.48 ~ 1.46), p = 0.54 for the overall effect]. EGDM improved muscle strength [ MD = 4.94, 95% CI (3.39 ~ 6.50), I ² = 59%, p = 0.02 for heterogeneity], shortened the duration of mechanical ventilation [ MD = −81.95 h, 95% CI (−115.45 ~ −48.46), p < 0.00001 for the overall effect; I ² = 85%, p < 0.00001 for heterogeneity], and reduced ICU stay[ MD = -4.55 days, 95% CI (−6.22 ~ −2.89), p < 0.00001 for the overall effect; I ² = 74%, p = 0.0004 for heterogeneity], both with substantial heterogeneity. Although the primary Barthel Index analysis was not statistically significant, sensitivity analysis suggested improvement in patients with moderate baseline function [ MD = 8.27, 95% CI (5.66 ~ 10.87), p < 0.00001 for the overall effect].
Conclusion: EGDM may improve muscle strength and physical function in ICU patients. The available evidence does not confirm a reduction in ICU-AW. The effects on ventilation duration and ICU stay varied substantially across studies, likely influenced by sedation protocols, weaning practices, and other context-specific factors. Further rigorous trials with detailed reporting of interventions and contextual factors are needed to guide precise clinical implementation.
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261280603 , CRD420261280603.
Related
- The lived experience of critical care nurses caring for patients with intensive care unit-acquired weakness: a qualitative study
- Clinical Factors and Composite Biomarkers Associated with Intensive Care Unit-Acquired Weakness: A Retrospective Cohort Study
- Toward precision host-directed immunomodulation in community-acquired pneumonia: a proposed endotype–target–natural-product framework and a roadmap for validation in human lung organoids
- Early mobilization in surgery: a narrative historical review of its evolution and contemporary implications
- Association of synergistic trajectories between early mobilization potential and actual implementation with clinical outcomes among ICU patients with pneumonia: a multivariate latent class mixed model analysis
BibTeX
@article{zhou2026impact,
title = {{Impact of early goal-directed mobilization on ICU-acquired weakness: a meta-analysis}},
author = {Jiayi Zhou and Lifei Dai and Xiaoli Liu and Junlian Xiang},
journal = {Frontiers in neurology},
year = {2026},
month = sep,
doi = {10.3389/fneur.2026.1922493},
url = {https://europepmc.org/article/PMC/PMC13661485},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impact of early goal-directed mobilization on ICU-acquired weakness: a meta-analysis
AU - Jiayi Zhou
AU - Lifei Dai
AU - Xiaoli Liu
AU - Junlian Xiang
PY - 2026
DA - 2026/09/30
JO - Frontiers in neurology
DO - 10.3389/fneur.2026.1922493
UR - https://europepmc.org/article/PMC/PMC13661485
AB - Background: ICU-acquired weakness (ICU-AW) significantly impairs muscle strength and physical function in critically ill patients. Early mobilization interventions have been increasingly adopted, yet the specific effects of a structured EGDM program on ICU-AW and functional outcomes have not been systematically quantified. This meta-analysis aimed to evaluate the effects of EGDM on ICU-AW, muscle strength, and functional outcomes. Methods: PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Viper Information Products (VIP) databases were searched for randomized controlled trials (RCTs) up to November 30, 2025. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2.0. RevMan 5.4 was used for meta-analysis. Subgroup analysis was prespecified by allocation concealment. Results: Nine RCTs (907 patients) were included. EGDM reduced ICU-AW [ RR = 0.57, 95% CI (0.33 ~ 0.97), p = 0.04 for the overall effect ; I ² = 77% , p = 0.002 for heterogeneity], but sensitivity analysis of high-quality trials showed no significant effect [ RR = 0.84, 95% CI (0.48 ~ 1.46), p = 0.54 for the overall effect]. EGDM improved muscle strength [ MD = 4.94, 95% CI (3.39 ~ 6.50), I ² = 59%, p = 0.02 for heterogeneity], shortened the duration of mechanical ventilation [ MD = −81.95 h, 95% CI (−115.45 ~ −48.46), p < 0.00001 for the overall effect; I ² = 85%, p < 0.00001 for heterogeneity], and reduced ICU stay[ MD = -4.55 days, 95% CI (−6.22 ~ −2.89), p < 0.00001 for the overall effect; I ² = 74%, p = 0.0004 for heterogeneity], both with substantial heterogeneity. Although the primary Barthel Index analysis was not statistically significant, sensitivity analysis suggested improvement in patients with moderate baseline function [ MD = 8.27, 95% CI (5.66 ~ 10.87), p < 0.00001 for the overall effect]. Conclusion: EGDM may improve muscle strength and physical function in ICU patients. The available evidence does not confirm a reduction in ICU-AW. The effects on ventilation duration and ICU stay varied substantially across studies, likely influenced by sedation protocols, weaning practices, and other context-specific factors. Further rigorous trials with detailed reporting of interventions and contextual factors are needed to guide precise clinical implementation. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261280603 , CRD420261280603.
SN - 1664-2295
ER -