Non-pharmacological rehabilitation strategies for pulmonary and physical recovery in ICU survivors after COVID-19: A systematic review

BackgroundSurvivors of severe COVID-19 requiring intensive care frequently experience persistent pulmonary and functional impairment consistent with post-critical illness sequelae. The effectiveness of non-pharmacological rehabilitation in this severity-specific subgroup remains uncertain.MethodsA systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Epistemonikos, LILACS, and Google Scholar were searched for randomized and observational studies evaluating non-pharmacological rehabilitation in adult ICU survivors of COVID-19. Risk of bias was assessed using RoB 2 and ROBINS-I tools. Given substantial clinical and methodological heterogeneity, quantitative meta-analysis was not performed; a structured narrative synthesis was undertaken.ResultsFourteen studies met inclusion criteria. Five incorporated comparator groups, while nine employed uncontrolled pre-post designs. Interventions ranged from early ICU mobilization to inpatient and outpatient pulmonary rehabilitation. Controlled studies reported variable between-group benefits in dyspnea and functional outcomes, whereas observational studies consistently described within-group improvement over time. However, most studies were at moderate to serious risk of bias, and heterogeneity in intervention timing, dosage, and outcome assessment limited comparability.ConclusionsNon-pharmacological rehabilitation in ICU survivors of COVID-19 is associated with improvement over time; however, the certainty of causal effectiveness remains low. ICU survivors constitute a distinct recovery population within the broader post-COVID spectrum. Adequately powered, multicenter randomized trials with standardized protocols and harmonized outcomes are required to establish long-term effectiveness.