Effects of in-bed cycling in critically ill adults: A systematic review and meta-analysis of randomised clinical trials

Abstract

Background. Impairments in intensive care unit (ICU) survivors can last up to 5 years post-discharge. Finding effective treatments to palliate and prevent them is essential, and in-bed cycling is a way to palliate the effects of prolonged immobilisation. Objective. To evaluate the effects of in-bed cycling in critically ill adults regarding recovery status, mortality, physical performance and quality of life. Methods. We followed PRISMA 2020 guidelines. The search was conducted in Cinahl, Medline, Scopus and Web of Science from their inception to October 2024. We included randomised clinical trials with critically ill adults who performed in-bed cycling alone or with another treatment while in ICU, compared to no intervention, placebo, rehabilitation or standard care, assessing recovery status, mortality, physical performance or quality of life. Methodological quality and risk of bias were evaluated. A meta-analysis was performed. Results. Thirty-two studies were included in the review, and 22 studies in the meta-analysis. A total of 3,052 participants (≥18 years old) admitted to different types of ICUs were included. Results showed significant differences regarding ICU length of stay (n = 1,564; MD −0.93; 95 % CI −1.64 to −0.21; P = 0.01) and hospital length of stay (n = 1,189; MD −1.78; 95 % CI −3.16 to −0.41; P = 0.01), mechanical ventilation duration (n = 1,024; MD −0.51; 95 % CI −0.92 to −0.11; P = 0.01) and functional status (n = 400; MD 44.88; 95 % CI 3.11–86.65; P = 0.04) favouring in-bed cycling plus rehabilitation compared to rehabilitation. However, no significant differences were found regarding mortality, muscle strength, ICU-acquired weakness or quality of life. Different programme duration did not significantly affect hospital length of stay. Conclusion. In-bed cycling plus rehabilitation significantly reduced ICU and hospital length of stay, mechanical ventilation duration and improved functional status compared to rehabilitation. Further research is needed to analyse long-term effects and standardise interventions. Trial Registration. PROSPERO International Prospective Register of Systematic Reviews CRD42022309311; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022309311.