Non-pharmacological interventions in adult ICU patients did not improve health-related quality of life in this network meta-analysis

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Frontiers in Medicine Published May 30, 2026 Medically reviewed May 30, 2026 Study authors: Wenhui Yu, Lei Huang, Dan Lv, Meng Li, Yanlin Huang, Yushi Li, Xiaoping Wang DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Note that non-pharmacological ICU interventions did not significantly improve quality of life in this network meta-analysis.

This network meta-analysis assessed the impact of non-pharmacological interventions on health-related quality of life in adult ICU patients. The study population comprised 2,654 patients across various intensive care unit settings. Interventions examined included ICU diaries, cognitive therapy plus mobile applications, electrical muscle stimulation plus physical activity, the ABCDE bundle, structured physical activity, and application-based cognitive therapy. These were compared against usual care, placebo, or other non-pharmacological interventions.

The primary outcome measured health-related quality of life using tools such as SF-36, SF-12, or EQ-5D. Secondary outcomes included the physical component summary and mental component summary. The analysis found that ICU diary showed a standardized mean difference of -0.30, while cognitive therapy plus mobile application showed -0.26. Electrical muscle stimulation plus physical activity showed -0.06. All confidence intervals crossed zero, indicating no statistically significant effect.

For the physical component summary, the ABCDE bundle showed a standardized mean difference of -0.50 and structured physical activity showed 0.08. For the mental component summary, the ABCDE bundle showed -0.43 and application-based cognitive therapy showed -0.18. The authors note that none of the interventions reached statistical significance. Consequently, the ABCDE bundle and ICU diary appear most promising but require further validation.

The study authors state that findings must be interpreted cautiously. No intervention demonstrated statistically significant superiority. The authors recommend further high quality, multicenter randomized controlled trials to validate these results and assess long term outcomes. Safety data such as adverse events or discontinuations were not reported.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

Intensive care unit (ICU) patients often experience long-term physical and psychological impairments that reduce health-related quality of life (HRQoL). Non-pharmacological interventions (NPIs) are increasingly used, but their comparative effectiveness remains uncertain. To systematically evaluate NPIs for improving HRQoL in ICU patients using a network meta-analysis (NMA), following PICOS and PRISMA-NMA guidelines. Systematic review and NMA with a pre-registered protocol (PROSPERO: CRD42024626250). We searched PubMed, Embase, Cochrane Library, Web of Science, and EBSCO to November 2024 for randomized controlled trials enrolling adult ICU patients, comparing NPIs with usual care, placebo, or other NPIs. Eligible studies reported validated HRQoL outcomes (SF-36, SF-12, or EQ-5D). Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. NMA was conducted using RevMan 5.3 and Stata 17.0. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated, and interventions were ranked by surface under the cumulative ranking curve (SUCRA). Only published, peer-reviewed data were included. Nineteen RCTs (2,654 patients, 12 NPIs) met inclusion criteria. For overall HRQoL, ICU diary (SMD: −0.30; 95% CI: −0.71–0.10), cognitive therapy plus mobile application (APP+CT) (SMD: −0.26; 95% CI: −0.85–0.33), and electrical muscle stimulation plus physical activity (EMS + PA) (SMD: −0.06; 95% CI: −0.72–0.59) showed the highest SUCRA probabilities. For physical component summary (PCS), the ABCDE bundle (SMD: −0.50; 95% CI: −1.61–0.60) and structured PA (SMD: 0.08; 95% CI: −0.89–1.06) ranked highest. For mental component summary (MCS), the ABCDE bundle (SMD: −0.43; 95% CI: −1.33–0.46) and application-based cognitive therapy (SMD: −0.18; 95% CI: −0.92–0.55) had the greatest probability of benefit. However, none reached statistical significance, as all confidence intervals crossed zero; SUCRA rankings reflect relative probability rather than confirmed effectiveness. This NMA found no intervention with statistically significant superiority. ICU diary and the ABCDE bundle appear most promising, yet findings must be interpreted cautiously. Further high quality, multicenter RCTs are needed to validate these results and assess long term outcomes. PROSPERO registration number: CRD42024626250. URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024626250.