Home‐Based Combined Activity and Cognitive Intervention for Post‐Intensive Care Syndrome: A Pilot Randomised Controlled Trial
Polly W. C. Li, C. K. Tong, Peter C. K. Lai, Pauline Y. Ng, Sampson C. S. Chan, M. H. Ho, Doris S. F. YuABSTRACT
Background
ICU survivors frequently develop post‐intensive care syndrome (PICS), a cluster of persistent physical, cognitive and psychological impairments that substantially impair recovery and quality of life. Existing rehabilitation approaches are predominantly monomodal and exercise‐focused, yielding inconsistent outcomes and failing to address the multidimensional burden of PICS adequately.
Aim
To evaluate the feasibility and preliminary efficacy of COMBAT‐ICU, a home‐based Combined Activity and Cognitive Intervention for ICU survivors at risk of PICS.
Study Design
A parallel, three‐arm, assessor‐blinded pilot randomised controlled trial randomised 36 ICU survivors (1:1:1) to COMBAT‐ICU—an 8‐week blended program of progressive physical exercise and computerised cognitive training delivered via supervised home visits and online sessions—an exercise‐only group or an attention control group. The primary outcomes were feasibility (recruitment, retention and intervention adherence) and safety; secondary exploratory outcomes encompassed PICS severity, physical capacity, cognition, mental health and health‐related quality of life (HRQoL).
Results
COMBAT‐ICU was feasible and safe (36 ICU survivors randomised), with no serious adverse events recorded, retention exceeding 82% at follow‐up and session adherence exceeding 90%. COMBAT‐ICU produced significantly greater reductions in PICS severity versus attention control at post‐intervention ( p = 0.014, d = −0.50) and follow‐up ( p = 0.043, d = −0.45). It also yielded clinically meaningful moderate‐to‐large effect sizes for walking endurance, global cognition, short‐term memory and HRQoL index scores compared with attention control and consistently outperformed exercise‐only across cognitive and HRQoL domains. Between‐group differences in anxiety and depressive symptoms were small across all active groups.
Conclusions
COMBAT‐ICU is feasible and shows promising preliminary efficacy in mitigating PICS. Integrating cognitive and physical training within a home‐based blended delivery model may confer synergistic benefits beyond exercise alone, providing domain‐specific effect size estimates and a compelling rationale for definitive multicentre trials.
Relevance to Clinical Practice
Multidomain home‐based rehabilitation is a viable post‐discharge strategy for ICU survivors. COMBAT‐ICU offers an evidence‐informed, scalable framework to enhance survivorship care, pending confirmation in larger, fully powered trials.
Trial Registration
The trial was registered at