Effectiveness of rehabilitation interventions on the secondary consequences of surviving a cardiac arrest: a systematic review and meta-analysis

Joshi, V. L., Christensen, J., Lejsgaard, E., Taylor, R. S. , Zwisler, A. D. and Tang, L. H. (2021) Effectiveness of rehabilitation interventions on the secondary consequences of surviving a cardiac arrest: a systematic review and meta-analysis. BMJ Open, 11(9), e047251. (doi: 10.1136/bmjopen-2020-047251) (PMID:34475160)

Abstract

Aim: The aim of this systematic review was to assess the effectiveness of rehabilitation interventions on the secondary physical, neurological and psychological consequences of cardiac arrest (CA) for adult survivors. Methods: A literature search of electronic databases (MEDLINE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica database, Psychological Information Database, Web of Science and Cochrane Central Register of Controlled trials) was conducted for randomised controlled trials (RCTs) and observational studies up to 18 April 2021. The primary outcome was health-related quality of life (HRQoL) and main secondary outcome was neurological function with additional secondary outcomes being survival, rehospitalisation, safety (serious and non-serious adverse events), psychological well-being, fatigue, exercise capacity and physical capacity. Two authors independently screened studies for eligibility, extracted data and assessed risk of bias. Results: Three RCTs and 11 observational studies were included (total 721 participants). Study duration ranged from 8 weeks to 2 years. Pooled data from two RCTs showed low-quality evidence for no effect on physical HRQoL (standardised mean difference (SMD) 0.19, (95% CI: −0.09 to 0.47)) and no effect on mental HRQoL (SMD 0.27 (95% CI: −0.01 to 0.55)). Regarding secondary outcomes, very low-quality evidence was found for improvement in neurological function associated with inpatient rehabilitation for CA survivors with acquired brain injury (SMD 0.71, (95% CI: 0.45 to 0.96)) from five observational studies. Two small observational studies found exercise-based rehabilitation interventions to be safe for CA survivors, reporting no serious or non-serious events. Conclusions: Given the overall low quality of evidence, this review cannot determine the effectiveness of rehabilitation interventions for CA survivors on HRQoL, neurological function or other included outcomes, and recommend further high-quality studies be conducted. In the interim, existing clinical guidelines on rehabilitation provision after CA should be followed to meet the high burden of secondary consequences suffered by CA survivors. PROSPERO registration number: CRD42018110129.

• Item Type: Articles
• Additional Information: This study was supported by infrastructure provided by REHPA, Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital which receives funding from the Danish Government. This study is part of a PhD partially funded by a PhD Faculty scholarship (no grant number) from the University of Southern Denmark and a stipendium from the Region of Southern Denmark (19/15041).
• Keywords: Rehabilitation medicine, fatigue, exercise therapy, heart arrest, quality of life, adult cardiology, neurological injury, survivors.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Taylor, Professor Rod
• Authors: Joshi, V. L., Christensen, J., Lejsgaard, E., Taylor, R. S., Zwisler, A. D., and Tang, L. H.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: BMJ Open
• Publisher: BMJ Publishing Group
• ISSN: 2044-6055
• ISSN (Online): 2044-6055
• Published Online: 02 September 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in BMJ Open 11(9): e047251
• Publisher Policy: Reproduced under a Creative Commons License