Original Investigation 

Caring for the Critically Ill Patient

Integrated Telehealth Rehabilitation and Quality of Life in Mechanically Ventilated Adults: A Randomized Clinical Trial

Regis Goulart Rosa, Rafael Barberena Moraes, Geraldine Trott, et al

JAMA Published Online: June 10, 2026

doi: 10.1001/jama.2026.10617

Key Points

Question  Among adults with acute hypoxemic respiratory failure requiring invasive mechanical ventilation, does an integrated multicomponent telehealth-based rehabilitation intervention delivered across the intensive care unit, hospital ward, and postdischarge periods improve health-related quality of life at 90 days after hospital discharge compared with usual care?

Findings  In this stepped-wedge cluster randomized clinical trial including 1916 patients, mean quality of life utility scores at 90 days after hospital discharge were higher in the intervention group (0.16; SD, 0.31) than in the usual care group (0.12; SD, 0.28). This improvement appeared to be primarily associated with lower mortality rather than higher postdischarge quality-of-life scores among survivors.

Meaning  In this study, among adults with acute hypoxemic respiratory failure requiring invasive mechanical ventilation, an integrated telehealth-based rehabilitation strategy spanning ICU, hospital ward, and postdischarge phases improved 90-day health-related quality of life.

Abstract

Importance  Whether integrated rehabilitation strategies spanning intensive care unit (ICU), hospital, and postdischarge phases improve quality of life after acute respiratory failure is uncertain.

Objective  To evaluate the effect of an integrated multicomponent telehealth-based rehabilitation intervention on health-related quality of life at 90 days after hospital discharge among adults with acute hypoxemic respiratory failure requiring invasive mechanical ventilation.

Design, Setting, and Participants  This stepped-wedge cluster randomized clinical trial in ICUs of 20 public hospitals in Brazil enrolled adults with acute hypoxemic respiratory failure requiring invasive mechanical ventilation between June 2024 and May 2025, with follow-up through September 2025.

Interventions  A multicomponent telehealth-based rehabilitation program integrating an ICU telehealth-based rehabilitation intervention focused on ventilator liberation; a ward telehealth-based rehabilitation intervention targeting risk stratification and initiation of individualized rehabilitation plans; and a postdischarge telehealth-based rehabilitation intervention consisting of a 2-month personalized centralized telerehabilitation program.

Main Outcomes and Measures  Health-related quality of life at 90 days after hospital discharge, measured using the EuroQol 5-Dimension 3-Level (EQ-5D-3L) utility score (range, −0.17 [worse than death] to 1 [best health state], with 0 representing death).

Results  Among 1916 enrolled patients (mean [SD] age, 60.6 [17.3] years; 43.6% female), 1063 were assigned to the intervention and 853 to usual care per local protocols. At 90 days after hospital discharge, mean (SD) EQ-5D-3L utility scores were higher in the intervention group than in the usual care group (0.16 [0.31] vs 0.12 [0.28]; adjusted difference, 0.049; 95% CI, 0.0002 to 0.098; P = .04) but did not differ among survivors (0.60 [0.32] vs 0.59 [0.32]; adjusted difference, −0.045; 95% CI, −0.138 to 0.045; P = .34). Compared with usual care, the intervention resulted in lower 90-day all-cause mortality (71.8% [676 of 941] vs 78.3% [584 of 746]; adjusted difference, −7.6%; 95% CI, −14.7% to −0.6%; P = .03) and shorter mean (SD) mechanical ventilation duration (9.9 [10.3] vs 15.5 [15.9] days; adjusted difference, −6.2 days; 95% CI, −8.5 to −3.9; P < .001).

Conclusions and Relevance  In this study, an integrated telehealth-based rehabilitation strategy delivered across ICU, hospital, and postdischarge phases improved 90-day health-related quality of life, potentially influenced by reduced mortality.

Trial Registration  ClinicalTrials.gov Identifier: NCT06343545