TableĀ 6

Recommendations and rationale for future research

Future interventional trial
Evidence Focus on NMES interventions delivered in the ICU or physical rehabilitation interventions delivered after ICU dischargeThe current evidence for these specific areas is currently low and/or insufficient. Focusing on these topics would address gaps in the existing evidence base
Population Define target population to benefit from interventionsStratification of patient cohorts that would benefit from rehabilitation interventions would streamline the rehabilitation pathway, greater efficiency of resource utilisation and cost-effectiveness as well as delivering personalised care
Intervention Full and accurate reporting of intervention detail using Template for Intervention Description and Replication checklist and guide44Increase transparency of intervention delivered within the trial, improve reporting of interventions in a systematic and structured manner, enhance interpretation of findings
Comparison Accurate and detailed description of usual care or the comparative intervention arm should be documentedFacilitate understanding of the clinical context in which the intervention was trialled, and assist in interpretation of findings and determining generalisability
Outcomes When available, use one or more relevant COS, for example, Connolly et al.45 In addition, ensure inclusion of a patient-reported outcome, long-term outcomes to fully evaluate effect of physical rehabilitation interventions and report adverse events or harms associated with the interventionCOS facilitate greater comparison across studies, pooling of datasets for meta-analyses and clinical applicability of results. Patient-reported outcomes were not evident from the current overview, and long-term follow-up was limited. Adverse event rates are valuable for considering clinical efficacy of an intervention even if statistically significant differences are observed
Timepoint Up-to-date literature search to underpin research question; further updated at the time of trial publicationEnsure trial findings are reported in context of most current existing data
Publication of a priori trial protocol developed in line with Standard Protocol Items: Recommendations for Interventional Trials guidanceEnhances credibility of final publication of trial findings by supplementing clinical trial registration; streamlines final publication text; comprehensive reporting of key trial components facilitates transparency
Include a process evaluation framework into trial design of complex interventions46To distinguish true intervention effect from factors related to delivery of intervention and trial conduct; explain contextual influences and provide insight into wider implementation
  • COS, core outcome sets; ICU, intensive care unit; NMES, neuromuscular electrical stimulation.