ASSOBRAFIR clinical practice guidelines in intensive care physical therapy: Rehabilitation strategies in critically ill adults.

Brazilian Journal of Physical Therapy 2026-10-01

Saint-Clair Gomes Bernardes Neto, Bruno Prata Martinez, Adriana Claudia Lunardi, Alexandre Simões Dias, Alexia Gabriela da Silva Vieira, Amanda Moreira Ferreira, Ana Carolina Pereira Nunes Pinto, André Luiz Lisboa Cordeiro, Ariany Marques Vieira, Bruno Leonardo da Silva Guimarães, Caio César Araújo Morais, Caroline Gomes Mól, Caroline Mosimann Souza, Daniel Ribeiro da Cunha, Darlan Laurício Matte, Debora Stripari Schujmann, Fernando Silva Guimarães, Gabriel Victor Guimarães Rapello, Graziella França Bernardelli Cipriano, Gustavo dos Santos Ribeiro, Janaína Barcellos Ferreira, Katerine Cristhine Cani, Kelly Cattelan Bonorino, Lucas Oliveira Soares, Luiz Alberto Forgiarini Junior, Rayane Neves da Silva, Sergio Ricardo Menezes Mateus, Fernanda Cordoba Lanza, Gerson Cipriano

Abstract

Background Early mobilization and respiratory muscle training strategies are widely used by physiotherapists to prevent, reduce impairment, and rehabilitate critically ill patients. Guidelines are required to respond to specific questions for physiotherapists in clinical practice. Objective To provide evidence-based recommendations for rehabilitating intensive care unit (ICU) patients. Methods The Guideline International Network (GIN) and The Appraisal of Guidelines for Research & Evaluation (AGREE-II) recommendations and principles were followed. The guideline panel of specialists used the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach to appraise evidence quality and formulate recommendations from four key questions on the rehabilitation of critically ill patients. Treatment effects were assessed using systematic reviews and meta-analyses. Results The Guideline Panel recommends: 1. Structured and progressive early mobilization protocol over usual care (Strong recommendation [SR], Low to moderate certainty of evidence [LMCoE]) and 2. Inspiratory muscle training instead of usual care in mechanically ventilated adult patients undergoing difficult or prolonged weaning ([SR], Moderate certainty of evidence [MCoE]). The Guideline Panel suggests the following: 3. Against using passive mobilization alone compared with usual care in non-cooperative patients in the ICU (Conditional [CR], very low [VLCoE], and 4. Against inspiratory muscle training as a routine intervention compared with usual care ([CR] in mechanically ventilated adult patients under simple weaning, Low certainty of evidence [LCoE]). Conclusion These guidelines can assist healthcare professionals in structuring respiratory muscle training and mobilization strategies in critically ill patients.

View at publisher (DOI: 10.1016/j.bjpt.2026.101635)