Original Investigation 

Caring for the Critically Ill Patient

Remote Multicomponent Rehabilitation in Intensive Care Unit Survivors: A Randomized Clinical Trial

Brenda O’Neill, Judy M. Bradley, Bronwen Connolly, et al

JAMA Published Online: May 18, 2026

doi: 10.1001/jama.2026.7401

Key Points

Question  Does a remote multicomponent rehabilitation intervention improve quality of life in survivors of critical illness?

Findings  In this randomized clinical trial including 429 critically ill adults requiring mechanical ventilation for 48 hours or longer who were recruited within 12 weeks of hospital discharge, a remotely delivered rehabilitation intervention did not significantly improve health-related quality of life at 8 weeks (EuroQoL 5-dimension 5-level questionnaire mean utility score of 0.69 vs 0.67 for standard care).

Meaning  A multicomponent rehabilitation program did not significantly improve health-related quality of life at 8 weeks in intensive care unit survivors who required mechanical ventilation.

Abstract

Importance  Evidence for remote multicomponent rehabilitation among critical care survivors is sparse.

Objective  To investigate the effects of a 6-week, remote, multicomponent rehabilitation intervention in survivors of critical illness following discharge from the hospital after an intensive care unit (ICU) admission compared with standard care on health-related quality of life at 8 weeks.

Design, Setting, and Participants  Pragmatic, multicenter, assessor-blinded, randomized clinical trial conducted from December 2022 to November 2025 at 52 National Health Service hospitals in the UK. Participants were adults who had been discharged from the hospital within the last 12 weeks with an ICU admission (required mechanical ventilation for ≥48 hours during ICU stay).

Interventions  Individuals were randomized to a 6-week, remote, multicomponent, individualized, rehabilitation intervention incorporating weekly symptom management; targeted exercise; psychological support; and peer support and information commenced within 12 weeks of hospital discharge (n = 231) or standard care (n = 198).

Main Outcomes and Measures  The primary outcome was health-related quality of life at 8 weeks measured by the EuroQoL 5-dimension 5-level questionnaire (EQ-5D-5L) utility score (from −0.285 [worst/worse than dead] to 1 [best health]; minimum clinically important difference: 0.08) and analyzed using linear regression (adjusted for baseline covariates). The secondary outcomes included leg strength and exercise capacity; self-reported perception of fatigue, anxiety, or depression; illness perception; and acceptability of the intervention and any adverse events.

Results  Of the 3705 screened patients, 429 (12%) were randomized (mean age, 55.4 [SD, 13.9] years; 184 female [42.9%]; 245 male [57.1%]; and had median Acute Physiology and Chronic Health Evaluation II score of 18 [IQR, 14 to 22]). The mean EQ-5D-5L utility score at 8 weeks was 0.69 (SD, 0.26) in the intervention group compared with 0.67 (SD, 0.27) in the standard care group (adjusted mean difference, 0.04 [95% CI, –0.001 to 0.09]; P = .05). The intervention improved 4 of the 6 secondary outcomes, including leg strength and exercise capacity, fatigue, anxiety, and acceptability of the intervention and any adverse events; there was no change in perception of depression or illness.

Conclusions and Relevance  A 6-week, multicomponent, rehabilitation program did not improve health-related quality of life at 8 weeks after discharge in ICU survivors who required mechanical ventilation.

Trial Registration  isrctn.org Identifier: ISRCTN11266403