Exploring the effectiveness of eHealth interventions in treating Post Intensive Care Syndrome (PICS) outcomes: a systematic review

Background:<br />It remains unclear how to optimise critical care rehabilitation outcomes to reduce the constellation of long-term physical, psychological and cognitive impairments known as Post Intensive Care Syndrome (PICS). Possible reasons for poor recovery include access to care and delayed treatment. eHealth could potentially aid in increasing access and provide consistent care remotely. Our review aimed to evaluate the effectiveness of eHealth interventions on PICS outcomes.<br /><br />Methods:<br />Studies reporting eHealth interventions targeting Post Intensive Care Syndrome outcomes, published in Medline, CINAHL, PsycINFO, Embase, and Scopus from 30th January 2010 to 12th February 2024, were included in the review. Study eligibility was assessed by two reviewers and any disagreements were discussed between them or resolved by a third reviewer. Study quality and risk of bias were assessed using the Mixed Method Appraisal Tool. Further to the identification of effective strategies, our review also aimed to clarify the timeline of recovery considered and the outcomes or domains targeted by the interventions.<br /><br />Results:<br />Out of 3,673 articles screened, 13 studies were included in our review. Most studies were conducted in the early post discharge phase (i.e., < 3 months) and presented preliminary effectiveness of eHealth interventions on physical and psychological outcomes. Despite evidence suggesting an optimisation of rehabilitative effects when multiple domains are targeted in the intervention, research has yet to concurrently target all three domains of PICS. Though the interventions were described as feasible and acceptable in all studies, the lack of robust monitoring systems to track the PICS domain outcomes is indisputable.<br /><br />Conclusion:<br />Our systematic review highlighted the promising contributions of eHealth with preliminary support for the feasibility and effectiveness of interventions in the early stages of post-critical care rehabilitation. However, it also highlights the fragmented approach to the concept of PICS. The 3 domains should be viewed as interrelated and not as distinct areas of recovery. Future research needs to investigate an integrative approach to these three domains, explore potential domain interrelationships, consider the challenges associated with large-scale eHealth implementation, and greater use of remote monitoring systems. Despite these challenges, eHealth is a critical solution in providing access, continuity, and sustainable care in the post-critical care setting.