ORIGINAL RESEARCH article
Front. Med.
Sec. Geriatric Medicine
This article is part of the Research TopicDelirium in Focus: Advances in Prediction, Prevention, Diagnosis, and ManagementView all articles
Occupational Therapy Improves Functional Recovery and Reduces Delirium in Critically Ill Adults with and without Stroke: A Systematic Review and Meta-Analysis
Provisionally accepted
- 1Guangzhou University of Chinese Medicine, Guangzhou, China
- 2Guangdong Provincial Engineering Technology Research Institute of Traditional Chinese Medicine, Guangzhou, China
- 3Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
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Background: Post-intensive care syndrome (PICS), encompassing physical, psychological, and cognitive impairments, significantly compromises recovery in critical illness survivors. Although occupational therapy (OT) may mitigate functional decline, its efficacy in the intensive care unit (ICU) remains inadequately established. This systematic review and meta-analysis evaluated the impact of OT on clinical outcomes in critically ill adults. Methods: We searched PubMed, Embase, Web of Science, CINAHL, Cochrane Library, CNKI, Wanfang, and China Biomedical Literature Service System from inception to August 5, 2025 for randomized controlled trials (RCTs) assessing ICU-based OT. Primary outcomes included activities of daily living (ADL), delirium incidence, grip strength, and mechanical ventilation duration. Data were synthesized using RevMan 5.3, with continuous outcomes expressed as mean difference (MD) or standardized mean difference (SMD) and dichotomous outcomes as relative risk (RR), all with 95% confidence intervals (CIs). The certainty of evidence for each outcome was assessed using the GRADE approach. Results: Pooled analyses demonstrated that OT significantly enhanced ADL performance (SMD = 0.72, 95% CI [0.40, 1.05], P < 0.001), reduced the incidence of delirium (RR = 0.44, 95% CI [0.30, 0.63], P < 0.001), increased grip strength (MD = 3.90 kg, 95% CI [2.03, 5.76], P < 0.001), and shortened the duration of mechanical ventilation (SMD = -0.68, 95% CI [-0.99, -0.37], P < 0.001). The certainty of evidence (GRADE) was low for ADL, and moderate for delirium, grip strength, and mechanical ventilation duration. Subgroup analysis of stroke patients further demonstrated that OT significantly improved ADL performance (SMD = 0.81, 95% CI [0.42, 1.20], P < 0.001) and reduced delirium incidence (RR = 0.39, 95% CI [0.21, 0.72], P = 0.003), suggesting a particularly beneficial effect in this vulnerable population. Conclusions: This meta-analysis provides evidence that OT may enhance functional recovery, prevent delirium, and facilitate weaning in critically ill patients. However, the strength of the evidence is low to moderate, tempered by the limited number of trials, risk of bias, and observed heterogeneity. These findings underscore the need for further rigorous investigation to establish optimal protocols.
Keywords: Critical Care, Icu rehabilitation, Post-Intensive Care Syndrome (PICS), Occupational Therapy, Activities of Daily Living, Delirium, randomized controlled trials, systematic review and meta-analysis
Received: 27 Oct 2025; Accepted: 08 Dec 2025.
Copyright: © 2025 Hua, Qiu, Zeng and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hui Wang
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