Survivors of critical illness commonly face long-term physical, mental, cognitive, and social health complications, known as Post Intensive Care Syndrome (PICS). It can occur during prolonged admissions in the intensive care unit (ICU) and can last for years after hospital discharge. Yet, specific rehabilitation pathways for affected persons are lacking across the globe. The coronavirus pandemic has further exacerbated an already strained healthcare system with personnel shortages and limited resources. This leaves countless patients after a critical illness without access to physical rehabilitation. Moreover, uptake of evidence-based rehabilitation interventions remains low, despite recent high-quality evidence that physical rehabilitation reduces ICU and hospital length of stay, improves physical function and cognitive outcomes, and empowers patients in their recovery. Reasons for the poor implementation include recent trials presenting inconclusive findings regarding the effectiveness of physical rehabilitation, with some even indicating the potential for increased risk of both adverse events and mortality. This has led to uncertainty across the globe. Additionally, systematic reviews have shown methodological inconsistencies, poor intervention reporting and a large variation in usual care practices across the globe that complicate interpretation and implementation in clinical practice. Accordingly, the aims of this seminar are to highlight the impact of personalised physical rehabilitation on long-term health outcomes and how to apply it in clinical practice. Particularly, we will consider the consequences of heterogeneity in control group reporting and how even small changes can influence local clinical practice. We will explore the diversity and suitability of physical rehabilitation interventions ranging from passive movement to robotic devices and functional exercises such as sitting or walking. By critically reviewing the evidence, we will discuss the challenge of finding an optimal and safe dosage and recommend on an optimal and personalised approach for each patient across their trajectory of recovery. Participants of this seminar will learn how to balance physical activity and rest by using continuous monitoring of cardiorespiratory parameters and by learning to recognise signs of patient exhaustion. We will highlight how to collaborate with other healthcare professionals to provide personalised and functional physical rehabilitation and give practical tips for family involvement and patient participation to improve early outcomes and ultimately enhance recovery. Finally, we will provide clinicians at the bedside with practical recommendations from experienced physiotherapists working across the globe using evidence-based strategies such as mobilization protocols to maximize intervention frequency, and targeted goal-setting.  

In summary, by critically examining methodological inconsistencies and exploring practical strategies for an optimal and safe dosage, this symposium seeks to enhance the relevance and applicability of research findings in diverse healthcare settings, ultimately advancing physical rehabilitation after critical illness worldwide.

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