Effect of a structured early rehabilitation program on long-term functional recovery, quality of life, and survival in patients with severe acute pancreatitis: a randomized controlled trial

BACKGROUND: Prolonged immobilization in patients with severe acute pancreatitis (SAP) leads to profound physical deconditioning, yet structured rehabilitation protocols remain underexplored in this population. OBJECTIVE: To investigate the effects of a structured early rehabilitation nursing (ERN) program on short-term and long-term clinical outcomes, including length of stay, functional recovery, and survival, in patients with severe acute pancreatitis (SAP) admitted to the intensive care unit (ICU). METHODS: This single-center, prospective, randomized controlled trial was conducted from June 2019 to June 2024. A total of 400 eligible SAP patients admitted to the intensive care unit (ICU) were randomized (1:1) to either the ERN group (n = 200), receiving a protocolized, multidisciplinary rehabilitation program, or the control group (n = 200), receiving usual care. The primary outcome was hospital length of stay (LOS). Key secondary outcomes included ICU LOS, systemic inflammatory markers (CRP, IL-6), muscle strength (MRC sum score), activities of daily living (ADL), quality of life (WHOQOL-BREF), and 1-year all-cause mortality. Assessments were performed at baseline, discharge, and at 3, 6, and 12 months post-discharge. RESULTS: The ERN group had significantly shorter hospital LOS (11.5 ± 2.5 vs. 14.8 ± 3.1 days, P < 0.001) and ICU LOS (7.2 ± 2.1 vs. 10.5 ± 2.8 days, P < 0.001). At day 7, the ERN group showed lower levels of CRP (48.5 ± 15.2 vs. 95.3 ± 25.4 mg/L, P < 0.001) and IL-6 (55.2 ± 18.3 vs. 110.6 ± 30.1 pg/mL, P < 0.001). At discharge, the ERN group demonstrated superior muscle strength (MRC score: 52.4 ± 4.9 vs. 46.1 ± 5.8, P < 0.001) and functional independence (ADL score: 75.8 ± 8.1 vs. 62.5 ± 9.3, P < 0.001). These functional and quality of life benefits were sustained through the 12-month follow-up. Kaplan-Meier analysis revealed a significantly higher 1-year survival rate in the ERN group (95.0% vs. 87.5%; log-rank P = 0.012). The incidence of ICU-acquired complications was also lower in the ERN group (5.5% vs. 26.0%, P < 0.001). CONCLUSION: A structured, early rehabilitation nursing program for SAP patients effectively attenuates systemic inflammation, accelerates physical recovery, reduces length of stay, and improves long-term functional outcomes, quality of life, and 1-year survival. These findings support the integration of ERN as a standard of care in the management of critically ill SAP patients.