Rehabilitation in the Intensive Care Unit for Adults with Traumatic Brain Injury: A Systematic Review and Meta-analysis

Fiona Howroyd; David McWilliams; Jonathan Weblin; Hon Sing Geoffrey Wu; Grace Turner; Fang Gao Smith; Tonny Veenith; Niharika A Duggal; Zubair Ahmed

doi:10.1007/s12028-026-02551-x

Rehabilitation in the Intensive Care Unit for Adults with Traumatic Brain Injury: A Systematic Review and Meta-analysis

Fiona Howroyd
, David McWilliams
, Jonathan Weblin
, Hon Sing Geoffrey Wu
, Grace Turner
, Fang Gao Smith
, Tonny Veenith
, Niharika A Duggal
, Zubair Ahmed

University of Birmingham
University Hospitals Coventry and Warwickshire NHS Trust
University Hospitals Birmingham NHS Foundation Trust
Royal Wolverhampton NHS Trust

Research output: Contribution to journal › Article › peer-review

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Abstract

BACKGROUND: Traumatic brain injury (TBI) is a leading cause of disability worldwide. Rehabilitation in the intensive care unit (ICU) is a recommended intervention for the critically ill. However, the safety and effectiveness of physical rehabilitation in adults admitted to the ICU with TBI is currently unknown.

OBJECTIVES: The primary objective was to evaluate the safety of physical ICU rehabilitation in adults with TBI, and secondary outcomes aimed to evaluate its effect upon physical outcomes and length of admission.

METHODS: Five electronic databases were searched up to 1 September, 2025, including studies investigating physical ICU rehabilitation interventions in adults with acute TBI. A narrative synthesis of safety outcomes was conducted owing to heterogeneity. Meta-analysis was performed for secondary outcomes using the random-effects model to compare pooled data for rehabilitation and no-rehabilitation groups. Risk of bias was assessed using the ROBINS-E tool for observational studies and the RoB2 tool for randomised studies.

RESULTS: Overall, 13 studies consisting of 3582 adults with TBI were included. Four studies reported safety outcomes, reporting no or low rates of adverse events. Meta-analysis identified an increase in the Perme ICU Mobility Scores at ICU discharge in those that received ICU rehabilitation [Mean Difference 3.25 (2.05-4.44), p < 0.00001]. Risk of bias assessment identified very high risk of bias in observational studies and some concerns of bias in randomised studies.

CONCLUSIONS: Physical rehabilitation for adults with TBI in the ICU is potentially safe with suggested benefit upon mobility status at ICU discharge. Further high-quality studies of ICU rehabilitation for adults with TBI are required.

TRIAL REGISTRATION: PROSPERO CRD420251131380.

Original language	English
Pages (from-to)	(In-Press)
Number of pages	16
Journal	Neurocritical Care
Volume	(In-Press)
Early online date	23 May 2026
DOIs	https://doi.org/10.1007/s12028-026-02551-x
Publication status	E-pub ahead of print - 23 May 2026
Externally published	Yes

Bibliographical note

This article is licensed under a Creative Commons Attribution 4.0 International
License, which permits use, sharing, adaptation, distribution and reproduction
in any medium or format, as long as you give appropriate credit to the original
author(s) and the source, provide a link to the Creative Commons licence, and
indicate if changes were made. The images or other third party material in this
article are included in the article’s Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in the
article’s Creative Commons licence and your intended use is not permitted
by statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder.

Keywords

Critical care
Head injury
Mobilisation
Physical therapy
Rehabilitation

ASJC Scopus subject areas

Clinical Neurology
Critical Care and Intensive Care Medicine

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10.1007/s12028-026-02551-xLicence: CC BY

McWilliams2026VoRFinal published version, 3.21 MBLicence: CC BY

Cite this

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title = "Rehabilitation in the Intensive Care Unit for Adults with Traumatic Brain Injury: A Systematic Review and Meta-analysis",

abstract = "BACKGROUND: Traumatic brain injury (TBI) is a leading cause of disability worldwide. Rehabilitation in the intensive care unit (ICU) is a recommended intervention for the critically ill. However, the safety and effectiveness of physical rehabilitation in adults admitted to the ICU with TBI is currently unknown.OBJECTIVES: The primary objective was to evaluate the safety of physical ICU rehabilitation in adults with TBI, and secondary outcomes aimed to evaluate its effect upon physical outcomes and length of admission.METHODS: Five electronic databases were searched up to 1 September, 2025, including studies investigating physical ICU rehabilitation interventions in adults with acute TBI. A narrative synthesis of safety outcomes was conducted owing to heterogeneity. Meta-analysis was performed for secondary outcomes using the random-effects model to compare pooled data for rehabilitation and no-rehabilitation groups. Risk of bias was assessed using the ROBINS-E tool for observational studies and the RoB2 tool for randomised studies.RESULTS: Overall, 13 studies consisting of 3582 adults with TBI were included. Four studies reported safety outcomes, reporting no or low rates of adverse events. Meta-analysis identified an increase in the Perme ICU Mobility Scores at ICU discharge in those that received ICU rehabilitation [Mean Difference 3.25 (2.05-4.44), p < 0.00001]. Risk of bias assessment identified very high risk of bias in observational studies and some concerns of bias in randomised studies.CONCLUSIONS: Physical rehabilitation for adults with TBI in the ICU is potentially safe with suggested benefit upon mobility status at ICU discharge. Further high-quality studies of ICU rehabilitation for adults with TBI are required.TRIAL REGISTRATION: PROSPERO CRD420251131380.",

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author = "Fiona Howroyd and David McWilliams and Jonathan Weblin and Wu, \{Hon Sing Geoffrey\} and Grace Turner and Smith, \{Fang Gao\} and Tonny Veenith and Duggal, \{Niharika A\} and Zubair Ahmed",

note = "This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article{\textquoteright}s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article{\textquoteright}s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. ",

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doi = "10.1007/s12028-026-02551-x",

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T1 - Rehabilitation in the Intensive Care Unit for Adults with Traumatic Brain Injury

T2 - A Systematic Review and Meta-analysis

AU - Howroyd, Fiona

AU - McWilliams, David

AU - Weblin, Jonathan

AU - Wu, Hon Sing Geoffrey

AU - Turner, Grace

AU - Smith, Fang Gao

AU - Veenith, Tonny

AU - Duggal, Niharika A

AU - Ahmed, Zubair

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PY - 2026/5/23

Y1 - 2026/5/23

N2 - BACKGROUND: Traumatic brain injury (TBI) is a leading cause of disability worldwide. Rehabilitation in the intensive care unit (ICU) is a recommended intervention for the critically ill. However, the safety and effectiveness of physical rehabilitation in adults admitted to the ICU with TBI is currently unknown.OBJECTIVES: The primary objective was to evaluate the safety of physical ICU rehabilitation in adults with TBI, and secondary outcomes aimed to evaluate its effect upon physical outcomes and length of admission.METHODS: Five electronic databases were searched up to 1 September, 2025, including studies investigating physical ICU rehabilitation interventions in adults with acute TBI. A narrative synthesis of safety outcomes was conducted owing to heterogeneity. Meta-analysis was performed for secondary outcomes using the random-effects model to compare pooled data for rehabilitation and no-rehabilitation groups. Risk of bias was assessed using the ROBINS-E tool for observational studies and the RoB2 tool for randomised studies.RESULTS: Overall, 13 studies consisting of 3582 adults with TBI were included. Four studies reported safety outcomes, reporting no or low rates of adverse events. Meta-analysis identified an increase in the Perme ICU Mobility Scores at ICU discharge in those that received ICU rehabilitation [Mean Difference 3.25 (2.05-4.44), p < 0.00001]. Risk of bias assessment identified very high risk of bias in observational studies and some concerns of bias in randomised studies.CONCLUSIONS: Physical rehabilitation for adults with TBI in the ICU is potentially safe with suggested benefit upon mobility status at ICU discharge. Further high-quality studies of ICU rehabilitation for adults with TBI are required.TRIAL REGISTRATION: PROSPERO CRD420251131380.

AB - BACKGROUND: Traumatic brain injury (TBI) is a leading cause of disability worldwide. Rehabilitation in the intensive care unit (ICU) is a recommended intervention for the critically ill. However, the safety and effectiveness of physical rehabilitation in adults admitted to the ICU with TBI is currently unknown.OBJECTIVES: The primary objective was to evaluate the safety of physical ICU rehabilitation in adults with TBI, and secondary outcomes aimed to evaluate its effect upon physical outcomes and length of admission.METHODS: Five electronic databases were searched up to 1 September, 2025, including studies investigating physical ICU rehabilitation interventions in adults with acute TBI. A narrative synthesis of safety outcomes was conducted owing to heterogeneity. Meta-analysis was performed for secondary outcomes using the random-effects model to compare pooled data for rehabilitation and no-rehabilitation groups. Risk of bias was assessed using the ROBINS-E tool for observational studies and the RoB2 tool for randomised studies.RESULTS: Overall, 13 studies consisting of 3582 adults with TBI were included. Four studies reported safety outcomes, reporting no or low rates of adverse events. Meta-analysis identified an increase in the Perme ICU Mobility Scores at ICU discharge in those that received ICU rehabilitation [Mean Difference 3.25 (2.05-4.44), p < 0.00001]. Risk of bias assessment identified very high risk of bias in observational studies and some concerns of bias in randomised studies.CONCLUSIONS: Physical rehabilitation for adults with TBI in the ICU is potentially safe with suggested benefit upon mobility status at ICU discharge. Further high-quality studies of ICU rehabilitation for adults with TBI are required.TRIAL REGISTRATION: PROSPERO CRD420251131380.

KW - Critical care

KW - Head injury

KW - Mobilisation

KW - Physical therapy

KW - Rehabilitation

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U2 - 10.1007/s12028-026-02551-x

DO - 10.1007/s12028-026-02551-x

M3 - Article

C2 - 42174305

SN - 1541-6933

VL - (In-Press)

SP - (In-Press)

JO - Neurocritical Care

JF - Neurocritical Care

ER -

Rehabilitation in the Intensive Care Unit for Adults with Traumatic Brain Injury: A Systematic Review and Meta-analysis

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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