{"paper_id":"0820be80-a845-4049-a730-4833b7ab6ca2","body_text":"Exploring the effectiveness of eHealth interventions in treating Post Intensive Care Syndrome (PICS) outcomes: a systematic review. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring the effectiveness of eHealth interventions in treating Post Intensive Care Syndrome (PICS) outcomes: a systematic review. Daniel Lai, Zhao Liu, Elaine Johnston, Lisa Dikomitis, Teresa D'Oliveira, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4632511/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Sep, 2024 Read the published version in Critical Care → Version 1 posted 9 You are reading this latest preprint version Abstract Background: It remains unclear how to optimise critical care rehabilitation outcomes to reduce the constellation of long-term physical, psychological and cognitive impairments known as Post Intensive Care Syndrome (PICS). Possible reasons for poor recovery include access to care and delayed treatment. eHealth could potentially aid in increasing access and provide consistent care remotely. Our review aimed to evaluate the effectiveness of eHealth interventions on PICS outcomes. Methods: Studies reporting eHealth interventions targeting Post Intensive Care Syndrome outcomes, published in Medline, CINAHL, PsycINFO, Embase, and Scopus from 30th January 2010 to 12th February 2024, were included in the review. Study eligibility was assessed by two reviewers and any disagreements were discussed between them or resolved by a third reviewer. Study quality and risk of bias were assessed using the Mixed Method Appraisal Tool. Further to the identification of effective strategies, our review also aimed to clarify the timeline of recovery considered and the outcomes or domains targeted by the interventions. Results: Out of 3,673 articles screened, 13 studies were included in our review. Most studies were conducted in the early post discharge phase (i.e., < 3 months) and presented preliminary effectiveness of eHealth interventions on physical and psychological outcomes. Despite evidence suggesting an optimisation of rehabilitative effects when multiple domains are targeted in the intervention, research has yet to concurrently target all three domains of PICS. Though the interventions were described as feasible and acceptable in all studies, the lack of robust monitoring systems to track the PICS domain outcomes is indisputable. Conclusion: Our systematic review highlighted the promising contributions of eHealth with preliminary support for the feasibility and effectiveness of interventions in the early stages of post-critical care rehabilitation. However, it also highlights the fragmented approach to the concept of PICS. The 3 domains should be viewed as interrelated and not as distinct areas of recovery. Future research needs to investigate an integrative approach to these three domains, explore potential domain interrelationships, consider the challenges associated with large-scale eHealth implementation, and greater use of remote monitoring systems. Despite these challenges, eHealth is a critical solution in providing access, continuity, and sustainable care in the post-critical care setting. Critical Care Critical Illness Critical Care Rehabilitation Post-Intensive Care Syndrome eHealth Digital Health Technologies Figures Figure 1 Background Despite an overall increase in illness severity, a greater number of people are surviving critical care interventions [ 1 – 3 ] . Within the UK, hospital mortality dropped from 55–32% between 1988–2019 due to a myriad of factors, including increased bed capacity, faster recognition of sepsis, better pre- and in- critical care management [ 3 ] . Despite improved outcomes, there are a new set of challenges, with Post Intensive Care Syndrome (PICS) being increasingly recognised as an urgent problem among critical care survivors [ 4 ] . PICS is characterised as a sequalae of new or worsened physical, psychological, and cognitive impairments after critical illness which may persist beyond the critical care setting [ 5 ] . Approximately 25–55% of patients discharged from the critical care units will experience one or more of these impairments which can include pain, muscle weakness, sleep disturbances, issues with memory and attention, depression, anxiety, and Post Traumatic Stress Disorder [ 6 ] . PICS can persist for over 10 years post-discharge and has significant impacts on functional outcomes [ 7 ] , Health-Related Quality of Life (HRQoL) [ 8 ] , and employment [ 9 ] . Thus, the establishment of a rehabilitation pathway is essential for successful PICS management. Critical care rehabilitation consists of four phases: acute recovery and prevention within the critical care unit, recovery in the hospital ward, the first 3 months after hospital discharge termed the early post-discharge period, and the late post-discharge period which can span years after discharge [ 10 ] . Our review terms the three phases after critical care discharge as the ‘post-critical care’ phases. The effectiveness of current interventions in the post-critical care phases are limited with most targeting the late post-discharge period [ 11 , 12 ] . This limited effectiveness could be due to the timepoints chosen to begin rehabilitation (i.e., a later start of rehabilitation). The early post-discharge period is deemed a crucial recovery point where critical care survivors are most vulnerable. Despite the relevance of the initial phase of recovery post-hospital discharge, survivors are often restricted to the care and support of their General Practitioners. In the UK, not all critical care teams provide specialist follow-up clinics at the two-to-three-month time point after hospital discharge as per recommendations by the National Institute for Health and Care Excellence guidelines [ 13 ] . During the critical period between the hospital discharge and the 3-month follow-up appointment and in the absence of rehabilitation, PICS impairments may develop or worsen. These adverse impacts are further magnified by regional health inequalities due to their physical ability to access care, geographical location, and available local community resources [ 14 ] . Thus, there is a need for an earlier intervention and a continuity of care to improve patient outcomes of PICS recovery. The use of electronic Health (eHealth) technologies is presented by the literature as a solution to minimise health inequalities and facilitate earlier intervention. eHealth technologies are characterised by 1) enabling the storage, retrieval, and transmission of data, 2) supporting clinical decision making, and 3) to facilitate remote care [ 15 ] . These technologies include mobile applications, video conferencing, virtual reality, web platforms and wearable technology. eHealth solutions aim to offer improved patient care in a cost-effective manner and has been shown to improve access to care, quality of life and disease management [ 16 ] . The importance of eHealth and its relevance in healthcare was highlighted during the COVID-19 pandemic. With the demand of critical care services sharply rising, critical care across the globe had to adapt by embracing a tele-critical care model. The scaling up and usage of technology enabled reduced direct contact with COVID-19 patients [ 17 ] . Even in a post-pandemic world, tele-critical care provides additional benefits such as addressing workforce shortages, better access to specialist expertise, reduced patient transfers, lower ICU-mortality, and length of stay [ 18 , 19 ] . eHealth interventions can increase access to care and enables opportunities for critical care teams to foster better PICS recovery by starting rehabilitation treatment earlier. Though the use of eHealth technologies has proliferated within critical care, efforts in harnessing the benefits of eHealth have only just begun in a post-critical care setting. Evidence from other chronic patient populations like heart failure, stroke and diabetes have shown promising results in eHealth’s effectiveness on post-hospital disease management, medicine adherence, and health related quality of life [ 20 – 22 ] . However, specific identification and evaluation in a post-critical care setting is required due to the context-dependence of eHealth intervention uptake [ 23 ] . Studies conducted in the last 3 years demonstrate a demand for tools that can detect and measure rehabilitation of PICS symptoms [ 24 ] . The use of eHealth interventions to rehabilitate patients in the early post-discharge phase could promote better PICS recovery. To our knowledge, this is the first comprehensive review of eHealth’s impact on PICS outcomes during the critical care rehabilitation phase. This encompasses the in-hospital, early, and late post-discharge phases. The objective of the review is to identify effective strategies using eHealth that target PICS, their timeline in the recovery path and the outcomes addressed. As primary outcomes, we consider the PICS domains (physical, psychological and cognitive) targeted by the eHealth interventions, the recovery phase these interventions are implemented and their effectiveness. Secondary objectives include the feasibility of these eHealth interventions and identification of the barriers, and facilitators that encourage the uptake of eHealth interventions. Methods This systematic review is reported based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) [ 25 ] . The study was registered and published into the International Prospective Register of Systematic Review databases (PROSPERO registration number: CRD42023463036) [ 26 ] Search Strategy and Selection Criteria Search Strategy The following databases were searched: Medline, CINAHL, PsycINFO, Embase, and Scopus. Reference lists from key articles were also checked for any additional articles that fit the inclusion criteria. Due to the rapid innovation of eHealth technologies, studies that were published from 30th January 2010 to 12th February 2024 were included in this review. No restrictions were imposed on the language of publication. The PICO framework [ 27 ] was used to identify key terms and develop the search string. Since the comparator category is not relevant for this review, PIO was used. The categories were defined as (P): Post Intensive Care patients; (I): eHealth interventions; (O) Post Intensive Care Syndrome outcomes (Physical, Psychological, Cognitive). The Medline search string was (eHealth OR e-health OR mhealth OR tele-health OR telemedicine OR remote monitoring OR remote patient monitoring OR Wearable monitors OR physiological monitoring OR Virtual Reality) AND (Intensive Care Unit OR ICU OR Critical care OR critical care survivor* OR post intensive care discharge OR post-ICU OR Post Intensive Care Syndrome OR PICS) AND (Physical function OR ICU-acquired weakness OR Psychological outcomes OR Depression OR Anxiety OR PTSD OR Cognitive Outcomes OR Memory OR Attention OR executive function). The search string was tailored to fit the querying format of each database and can be found in the Supplementary Material S1. Study Inclusion and Exclusion Criteria Eligible studies included i) adults over the age of 18 who have been discharged from critical care (in the hospital ward, early post-discharge, and late post-discharge), ii) the inclusion of one or more eHealth interventions implemented in any of the three phases of post-critical care recovery, iii) PICS domains were measured as an outcome, vi) full text published in peer reviewed journals. There were no restrictions made on the study design and the language of publications. As current eHealth definitions proposed in the literature are very broad and general, we used the definition by Black et al., [ 15 ] to operationalise what constitutes as an eHealth intervention. The eHealth inclusions and exclusion criteria were developed based on this definition and the types of eHealth interventions were categorised in these categories. Telemedicine Telerehabilitaiton Self-directed interventions Remote patient monitoring (wearables, sensors) Virtual Reality (VR) Studies excluded consisted of i) no evidence of eHealth intervention, ii) Paediatric (children) ICU, iii) neonatal/prenatal ICU, iv) systematic reviews and meta-analyses, v) conference abstracts, and vi) study protocols. Selection Process Two reviewers (DL, ZL) independently screened the articles according to the stipulated inclusion and exclusion criteria. During the titles and abstract screening stage, screening procedures proposed by Adams et al. [ 28 ] were used. The first reviewer (DL) screened all titles and abstracts, while the second reviewer (ZL) screened a 10% random selection of articles. There was substantial inter-rater reliability between the reviewers (Kappa = 0.66; percentage agreement = 98.8%). Full-text screening was done independently by DL and ZL with almost perfect agreement (Kappa = 0.95, percentage agreement = 98.3%) Any disagreements were be discussed between the two reviewers until consensus was reached. When consensus could not be reached, the dispute was solved with the consultation of a senior team member (TD). Data Extraction Data extracted consisted of study characteristics (Author/year; Country; Study design; Population; Post-critical care timepoint; Sample size/Control (if any); Study duration), eHealth intervention characteristics (Intervention; Type of eHealth intervention; Delivery Format; Findings). Data extraction was done in duplicate by two reviewers (DL and ZL) who worked independently. Risk of Bias and Quality Assessment Two reviewers (DL, and ZL) independently assessed risk of bias and the quality of studies using the Mixed Methods Appraisal Tool (MMAT) [ 29 ] . The tool evaluates mixed method studies and is designed for mixed study systematic reviews. It examines and evaluates the appropriateness of a study’s aims, methodology, design, data collection, data analysis, presentation of findings, discussion, and conclusion. There are four questions regarding quality based on study type (quantitative, qualitative, or mixed method) and each study was scored using percentages based on the recommendations by Pace et al. [ 30 ] . Any disagreements were resolved through discussion between the two reviewers. Data Synthesis and Analysis A quantitative analysis of outcomes or meta-analysis could not be done due to the heterogeneity of the study designs, outcome measures used, eHealth interventions, and the critical care population. With the included studies, a qualitative narrative synthesis was undertaken to summarise the primary and secondary outcomes of interest. Data were grouped based on the main outcomes listed in the data extraction section. Results Initial database searches yielded 3,673 articles. Deduplication of 428 articles led to a total of 3,245 titles and abstracts screened. In accordance with the exclusion criteria, 3,186 articles were excluded leaving 59 articles for full text retrieval. Out of the 59 articles, 13 met the inclusion criteria for the current review. Figure 1 presents the PRISMA diagram documenting the processes of identifying, screening, and selection of included papers. Study Characteristics A total of 548 participants were enrolled across 13 studies. The sample sizes ranged from 5 to 89 with participant ages ranging from 47 to 72 years. Though the majority of the studies reported mature adults above 50 years of age, there is great variation in the average age across studies. Three studies had a mean age of below 50 [ 31 , 33 , 36 ] , 5 studies had a mean participant age below 62 [ 32 , 34 , 38 , 41 , 42 ] , and 3 studies had mean participant age below 73 [ 35 , 40 , 43 ] . Study design varied considerably across the studies with 46% (6/13) of studies being Randomised Controlled feasibility Trials (RCT) [ 31 – 33 , 36 , 41 , 42 ] , 38.4% (5/13) prospective observational cohort studies [ 34 , 35 , 38 , 40 , 43 ] , and 15.3% (2/13) qualitative studies looking at the acceptability and experiences of a telemedicine program and eHealth application [ 37 , 39 ] . Studies were conducted across 7 countries with majority coming from the United States (6/13). The characteristics and intervention descriptions of included studies are summarised in Table 1 . Table 1 Study characteristics, description of eHealth interventions and main findings. Author, Year Country Study Design Population Time point Sample/Control Duration Intervention Type of eHealth intervention Delivery format Main Findings Balakrishnan et al., 2023 [ 31 ] US Feasibility RCT Covid-19 patients Early post-discharge 40/ TAU 10 weeks Telemedicine visits 14 days post-hospital discharge in Covid-19 and ARDS survivors. Telemedicine/ Video call Video call • No significant difference in HRQOL, and anxiety. • Feasibility and acceptability concluded. • 75% of participants continued using provided pulse oximeter and Blood pressure monitor after study’s conclusion. Capin et al., 2022 [ 32 ] US Feasibility RCT Covid-19 patients Early post-discharge 44/ Active 12 weeks Telerehabilitation program which included 12 exercise sessions led by a physiotherapist. Tele-rehabilitation App • No significant difference in physical outcomes. • No significant difference in cognitive outcomes. • Feasibility and safety concluded 83% met 100% adherence. Cox et al., 2019 [ 33 ] US Feasibility RCT Medical, cardiac, and surgical ICU Early post-discharge 80/ Active 12 weeks Self-directed mindfulness application which delivered 4 mindfulness sessions consisting of background videos, guided meditation and educational materials Self-Directed eHealth intervention App • Mindfulness group has lower PTSD and Depressive symptoms and anxiety scores compared to group that received education. • Feasibility, acceptability, and usability concluded. • 71% adherence in intervention group. • Acceptability measure exceeded benchmark scores (M = 27.6, SD = 3.8). Denehy et al., 2012 [ 34 ] Australia ObservationalQuasi-experimental Medical ICU In-hospital 53 1 week Critical care survivors wore an actigraph for 7 days at 2 months post-hospital discharge Remote patient monitoring Wearable • Absence of chronic disease was significantly associated with increased distance walked (p < .000) where chronic disease explained 33.5% of the variance in average distance walked. • ICU survivors were inactive when quantitatively measured at 2 months after hospital discharge. • 63% of participants did not reach 30 minutes of moderate physical activity. Estrup et al., 2019 [ 35 ] Denmark ObservationalQuasi-experimental Medical, surgical ICU In-hospital 44 1 week Activity levels measured for 7 days in-hospital. Physical function outcomes were measured 3 months post-hospital discharge Continuous patient monitoring Wearable • Improved physical function in most patients 3-month post-hospital discharge. • Physical function correlated with mean daily activity (p = 0.017), maximum activity on second day (p = .0053), and total activity in the daytime (p = 0.0058). Jackson et al., 2012 [ 36 ] US Feasibility RCT Medical, surgical ICU Early post-discharge 21 /TAU 12 weeks A hybrid cognitive, physical and functional rehabilitation. physical and functional rehabilitation sessions were conducted via video call. Cognitive rehabilitation was done in-person Tele-rehabilitation Video call • Improvements in cognitive outcomes. • Improvements in instrumental activities of daily living (driving, shopping). • Feasibility concluded. • 76.9% adherence to intervention. Kovaleva et al., 2023 [ 37 ] US Qualitative ICU Sepsis and/or ARDS diagnosis Late post-discharge 24 12 weeks Video conference at 3- and 12- weeks post hospital discharge. Telemedicine Video call • All participants found telemedicine visit acceptable. • Technology was easy to use. • Reassured about mental health status. • Ways to improve intervention include 1. Increase visit frequency 2. Schedule visit sooner 3. Match visit schedules with individual recovery trajectories Park et al., 2023 [ 38 ] US Observational Quasi-experimental Covid-19 Late post-discharge 18 Up to 14 sessions Up to 14 virtual, evidence-based psychotherapy sessions for patients. Intervention integrated psychoeducation, cognitive restructuring, acceptance, exposure-based, and mindfulness. Tele-psychotherapy Video call • Significant decrease in participants meeting anxiety (57.1% decrease) and depression (57.2% decrease). • Feasibility concluded. • 77.8% adherence to intervention. Parker et al., 2020 [ 39 ] Australia Qualitative ARDS survivors Late post-discharge 10 N. A Application which consisted of educational resources on rehabilitation, a mood tracker, and a goal tracker Educational App • 80% stated application was easy to use. • 37% stated it would be helpful to have an application demonstration. • Median score for app ‘helpfulness’ was the maximum score of 5, IQR [4.24-5.00]. Rose et al., 2021 [ 40 ] UK Observational Quasi-experimental Medical, Surgical ICU Early post-discharge 5 12 weeks Delivered through online/mobile platform. The platform provided assessments of baseline status and recovery barriers, tailored e-resources based on recovery barriers, patient recovery e-diary. Telemedicine Web-based/ App • Two patients reported achieving short-term goals, 2 partially achieved goals, and 1 did not achieve. Vlake et al., 2021 [ 41 ] Netherlands Multi-centre feasibility RCT ICU Sepsis or septic shock diagnosis In-hospital 50/ Active 1 session Patients in the stepdown ward go through the ICU-VR intervention which includes different scenes in the ICU unit. Patients were then followed up 2 days, 1 week, 1 month, and 6 months after VR intervention Virtual Reality intervention Virtual Reality headset • PTSD and depression reduced in VR intervention group 2 days after exposure and persisted throughout follow up timepoints • HRQoL improved in VR intervention group up to 1 month after VR intervention. Did not improve 6 months after intervention • VR intervention group experienced greater sense of presence, involvement and experienced realism Vlake et al., 2022 [ 42 ] Netherlands Multi-centre feasibility RCT Covid-19 Late post-discharge 89/ TAU 1 session VR intervention is the same as intervention above but was trialed on a post-hospital discharge sample. Participants were followed up 1 and 3 months after 3-month post-icu clinic appointment Virtual Reality intervention Virtual Reality headset • Psychological outcomes and quality of life did not improve • Feasibility and acceptability concluded • Satisfaction in ICU aftercare rated higher in intervention group • 100% recommended the intervention to other patients • 100% adherence to 6-month follow-up Wood et al., 2018 [ 43 ] Canada Observational Quasi-experimental Medical, Surgical ICU Late post-discharge 70 2 sessions A screening tool where participants completed 7 tasks within a VR environment. Virtual Reality Screening Tool Virtual Reality • Prevalence of cognitive and sensorimotor impairments 9/28 (32%) and 3/22 (14%) participants displayed global cognitive impairment. • Screening tool caused little to no procedural discomfort • Provides additional sensorimotor function metrics than pen and paper testing cannot capture RCT Randomised Controlled Trial, TAU Treatment as usual, HRQoL Health Related Quality of Life, PTSD Post Traumatic Stress Disorder, ICU Intensive Care Unit, M Mean, SD Standard Deviation, ARDS Acute Respiratory Distress Syndrome, VR Virtual Reality -------------------------------- Insert Table 1 here (Page 11- Page 20) --------------------------- Interventions Targeting PICS There were a wide range of different eHealth interventions and delivery formats. 3 studies reported on telerehabilitation [ 32 , 36 , 38 ] , 2 studies looked at telemedicine [ 31 , 40 ] , 2 studies looked at patient monitoring [ 34 , 35 ] , 3 studies looked at virtual reality [ 41 – 43 ] , and 1 study team looked at a self-directed eHealth intervention [ 33 ] . The format of intervention delivery is associated with the domains that were targeted with the intervention: wearable sensors were associated with physical domains, the video conferencing was associated with physical and cognitive domains, self-help applications were associated with the psychological domain, and virtual reality was associated with psychological and cognitive domains. Out of the three domains, eHealth interventions targeted the psychological domain most frequently [ 31 , 33 , 38 , 40 , 41 , 42 ] , followed by the physical domain [ 31 , 32 , 34 – 36 ] and the cognitive domain being the least targeted [ 32 , 36 , 43 ] .Only three study teams designed interventions that covered two PICS domains [ 31 , 32 , 36 ] .There were no eHealth interventions that targeted all three PICS domains in tandem. Table 2 summarises the relationship between intervention delivery format and domains targeted. Table 2 Summary of targeted PICS domains of each eHealth intervention Author/Year Intervention Delivery format Physical Psychological Cognitive Denehy et al., 2012 [ 34 ] Wearable sensor x Estrup et al.,2019 [ 35 ] Wearable sensor x Jackson et al., 2012 [ 36 ] Video conference x x Capin et al., 2022 [ 32 ] Video conference x x Balakrishnan et al., 2023 [ 31 ] Video conference x x Park et al., 2023 [ 38 ] Video conference x Cox et al., 2019 [ 33 ] Application x Rose et al., 2021 [ 40 ] Web/Application x Vlake et al., 2021 [ 41 ] Virtual Reality x Vlake et al., 2022 [ 42 ] Virtual Reality x Wood et al., 2018 [ 43 ] Virtual Reality x Timing of Interventions The included eHealth interventions tackled the three phases of post-critical care rehabilitation. Most of the included studies (5/11 studies) chose the early post discharge phase [ 31 – 33 , 36 , 40 ] . For the other two phases, there were 3 studies [ 34 , 35 , 41 ] conducted in-hospital and 3 studies during the late post-discharge phase [ 38 , 42 , 43 ] . This result emphasizes the emergence of eHealth interventions addressing PICS impairments in the early post-discharge phase. In addition, it also highlights the potential of developing eHealth interventions in the late post-discharge phase to provide longitudinal care management to critical care survivors. eHealth Intervention Effects on PICS Outcomes Physical Outcomes The impact of eHealth interventions on physical function were mixed. Whilst Jackson et al. [ 36 ] found a significant effect on physical function with a multi-component telerehabilitation, Capin et al. [ 32 ] did not find any significant effects of physical function with a tele-physical therapy intervention. The multi-component intervention attributed its significant effects to the co-delivery of cognitive and physical rehabilitation that the tele-physical therapy intervention did not include. A significant improvement in physical function at 3 months post-discharge was significantly correlated with mean daily activity [ 35 ] . An absence of chronic disease is a majorly significant ( p < .000) predictor of increased distance walked post-hospital discharge explaining 33.5% of the variance in mean distance walked [ 34 ] . This result reiterates the importance of early rehabilitation in preventing the chronic impairments of PICS and the relevance of interventions targeting multiple domains to optimal rehabilitative effects. Psychological Outcomes Of the 6 studies that targeted psychological outcomes, 4 studies showed significant reductions in anxiety [ 38 ] , depression [ 33 , 38 , 41 ] , and Post Traumatic Stress Disorder [ 33 , 41 ] . Only 2 studies showed no effects [ 31 , 42 ] . A possible reason for having no effects is that Balakrishnan et al. [ 31 ] study used telemedicine to provided care planning for participants rather than active rehabilitation provided by a physiotherapist or psychologist. In contrast, Vlake et al. [ 42 ] did not find significant improvements in psychological outcomes in a late post-discharge sample. However, a prior study conducted by the same authors found an improvement in psychological outcomes 2 days after exposure and persisted across other follow-up timepoints [ 41 ] . There could be a possibility that there is an optimal window for certain interventions to be effective. Overall, the included studies have provided promising results in alleviating psychological PICS symptoms with eHealth interventions. Cognitive Outcomes The two studies that targeted cognitive outcomes used the same telerehabilitation programmes used in the physical outcomes section [ 32 , 36 ] . Similarly, Capin et al. [ 32 ] did not find any improvement in cognitive outcomes while Jackson et al. [ 36 ] found significant improvement in executive functioning. The physiotherapy intervention only focussed on the physical domain and did not have a cognitive rehabilitation component unlike the multi-component intervention. Thus, a direct effect of measured cognitive outcomes would not have been observed. The incorporation of the cognitive domain is still incipient, and more evidence is required to determine eHealth’s impact. Wood et al. [ 43 ] tested a cognitive screening assessment using virtual reality. As the primary aim was to report the prevalence of cognitive impairments among survivors, the effects of screening intervention on cognitive outcomes were not evaluated. The study found that less pronounced cognitive impairment at 12 months compared to 3-month follow-up. Secondary Outcomes Feasibility All the included studies which explored feasibility (9 out of 13 studies) demonstrated feasibility of the various eHealth interventions. All studies had an adherence rate of more than 70%. One study had 71% adherence [ 33 ] , 4 studies had > 75% adherence [ 34 – 36 , 38 ] , 1 study had 83% adherence [ 32 ] , 1 study had 90% adherence [ 31 ], and 2 studies had 100% adherence [ 41 , 42 ] . Acceptability of eHealth Interventions Studies which reported acceptability included two qualitative studies [ 37 , 39 ] and 3 RCTs [ 31 , 33 , 42 ] . All studies concluded the intervention to be acceptable. The 3 RCT studies evaluated acceptability using a questionnaire and reported participant satisfaction. Balakrishnan et al. [ 31 ] mentioned that participants felt the telemedicine follow-up clinic provided assurance and that the equipment provided continued to be used even after the study. Vlake et al. [ 42 ] reported that the VR intervention group rated satisfaction with ICU aftercare significantly higher (p = .002) with 62% of the participants attributing that satisfaction to the VR intervention. All participants recommended the VR intervention to other ICU survivors. The two qualitative studies focused on the experiences of a telemedicine intervention and an app-based mood monitoring prototype system [ 37 , 39 ] . Regarding the barriers to the use of eHealth interventions, most themes considered the sensitivity of mental health and cognitive issues. Participants felt that labelling psychological impairments without a thorough assessment could affect engagement with the interventions. Participants from Kovaleva et al. [ 37 ] study mentioned that neuropsychological assessments felt ‘embarrassing’ when other clinicians were present in the video call. Participants in Parker et al. [ 39 ] study thought ‘depression’ was too stigmatising and suggested the term emotions/states as an option. It was also mentioned that the tracking of physical health (activity, heart rate etc.) would be beneficial. Usability and perceived usefulness were identified as the main facilitators to the use of eHealth interventions. Facilitators in the acceptability of eHealth interventions included the ease of using the intervention platforms, the convenience, and viewing the platform as a motivator of recovery. Telemedicine was proposed as the most feasible option for attending clinics remotely for some participants who may be too weak or unable to drive to the hospital [ 37 ] . With regards to remote monitoring, the system should encompass a rehabilitation programme with achievable goals as well as in-built reward systems to encourage motivation to engage with the intervention. Quality Assessment and Risk of Bias of Included Studies Quality assessments used the MMAT tool (Hong et al., 2018) with most studies running quantitative randomised controlled trials. Though included RCTs varied in quality, most of the studies were of high quality with 4 of 6 studies scoring 80% [ 32 , 33 , 36 , 42 ] and 2 studies scoring 60% [ 31 , 41 ] . The main limitations impacting study quality were due to incomplete outcome data and the inability to ‘blind’ participants. There was a greater variance in study quality for non-randomised quantitative studies with 2 high quality studies scoring 80% [ 34 , 35 ] , 2 studies moderate quality studies scoring 60% [ 38 , 43 ] and 1 low quality study scoring 20% [ 40 ] . The main limitations that impacted the low-quality study was the representativeness of the sample, selection of measures, and incomplete description of intervention as intended. The two qualitative studies were high-quality at 80% [ 37 ] and 100% [ 39 ] . The detailed rating and scoring of the MMAT tool can be found in Supplementary Material S2. Discussion Current critical care rehabilitation services demonstrate a lack of evidence for early acute rehabilitation beyond early mobilisation, a deprived access in crucial services like physio or psychological therapy that improves function, and no long-term care planning beyond the 3-month critical care rehabilitation clinic [ 11 – 14 ] . The main objectives of the study were to systematically assess and explore eHealth’s potential in addressing these gaps. Specifically, we evaluated the effectiveness of eHealth interventions in a post-critical care population and identified the PICS domains currently targeted. 3,673 articles were searched across 5 databases and 13 studies met the stipulated inclusion criteria. Most studies were conducted in the early post-discharge phase reflecting the field’s desire to devise interventions to solve these problems. Despite identifying a variety of eHealth interventions, research has yet to consider an intervention that targets all three domains of PICS. Within the post-critical care recovery phases, preliminary results of eHealth’s effectiveness on PICS outcomes were generally positive. Jackson et al. [ 36 ] attributed significant effects in physical and cognitive outcomes when combining rehabilitation of the two domains together, a result that contrasts with Capin et al. [ 32 ] programme which focussed on physical function only. The potential benefits and synergistic effects of performing physical exercise and cognitive training have been documented in other populations [ 44 ] . Interrelationships among the three domains are presented through the prevalence of PICS symptom comorbidities. Heesaker et al. [ 45 ] observed that mental health and cognitive impairment always occur simultaneously with the other two domains. Marra et al. [ 6 ] reported a combination of mental health and cognitive impairment occurring more frequently than other combinations. Kang et al. [ 46 ] built on those studies and found that 41.1% of critical care survivors with PICS had symptoms in two or more domains with Physical-Mental symptoms being the most prevalent. Our team proposes that rehabilitation should consider the underpinnings of the syndrome, i.e., the co-existence of symptoms across domains. It is the co-delivery of interventions across different domains of PICS that leverages positive health outcomes. To that end, care to all PICS domains in tandem requires a multi-disciplinary approach. We highlighted how current post-critical care research adopts a fragmented view to PICS. In the studies included in this review, physical, psychological, and cognitive domains are not targeted altogether either in rehabilitation interventions or in remote patient monitoring systems, the latter only assessing individual PICS domains. The potential benefits of multi-domain rehabilitation, give rise to the need to develop monitoring systems that can track these outcomes concurrently. Support for such proposal can be found in Parker et al. [ 39 ] where participants expressed the keenness for an option that monitors other aspects of health and recovery (on top of mood). Furthermore, current interrelationships between domains are inferred with prevalence studies. The specific roles each domain plays in PICS recovery have yet to be explored. Therefore, the proposal of a multi-domain intervention warrants remote monitoring systems sensitive in tracking these outcomes. This development aligns with patient centred outcomes, future post-critical care research, and clinical need. Most studies point to the feasibility of implementing eHealth interventions. The implementation of eHealth interventions into day-to-day clinical practice have been challenging [ 47 ] . The decision to adopt an eHealth intervention requires careful management of both patient and staff expectations [ 48 ] . Clinicians and hospital staff need to believe that the intervention can improve care and efficiency. They need to be on board, involved, and receive consistent support during the adoption [ 49 ] . The success of eHealth implementation is also determined by patient engagement and uptake. This is especially challenging in older patient populations like critical care survivors. Themes of usability and perceived usefulness highlighted in this review were in line with older patients with chronic conditions [ 50 ] , older patients with cancer [ 51 ] , and general older population [ 52 , 53 ] . Critical care survivors were more likely to adhere to eHealth interventions when they are easy to use, convenient and perceived as a motivator towards recovery. The continuous contact between patients and the clinical team through telemedicine visits supported the perceptions of care continuance, thus increasing the perceived usefulness and adherence to eHealth interventions. Despite the alignment with recommendations from research on senior populations, given that only two qualitative studies were included in the review, further research is needed to address the specific barriers and facilitators for eHealth uptake and engagement in the PICS population in general. Study Limitations One limitation of this review is the infancy of the current research area. The primary objective of studies included in the review was to assess the feasibility of the intervention resulting in underpowered studies with small samples. Despite the positive effects of eHealth on each PICS domain, the results are preliminary in nature. Nevertheless, the summarised evidence paints a promising picture in the development of eHealth interventions in this population. Future studies need to focus on larger scale RCTs which will provide more insight to intervention effectiveness. The authors of the ICU-VR intervention have progressed to a larger RCT trial [ 54 ] in hopes to generate more robust effects of the intervention on PICS outcomes. Other eHealth trials are also underway in this post-critical care phase of recovery [ 55 – 57 ] . Thus, whilst eHealth interventions can be concluded to be feasible, conclusions on effectiveness are premature at this point. Even though no restriction was imposed on the language and country of article publication, the language used in the search strategy undoubtedly constrained its results. We acknowledge that if the search terms included other languages, other articles could be deemed eligible. This review adhered closely to the PICO framework [ 27 ] and search strings were systematically piloted in preliminary searches. The review attempted to be as broad as possible regarding the search strategy and the databases selected. Future research may also benefit from the inclusion of Medical Subject Headings (MeSH) terms to further expand the search. Conclusions In this systematic review we highlighted the need for incorporating rehabilitation and monitoring systems that target the physical, psychological, and cognitive domains of Post Intensive Care Syndrome. Interventions to address PICS need to be holistic, not isolated to individual domains. Future research should consider the interrelationships between the three domains of PICS to optimise the intervention development. eHealth research and development in post-critical care rehabilitation is still early in its infancy with most studies focusing on feasibility and acceptability. Preliminary results are promising and generally positive in effectiveness with research progressing to larger scale studies to derive more robust conclusions. eHealth is one vital solution in providing access, continuity, and sustainable care in the post-critical care setting. Abbreviations ICU Intensive Care Unit PICS Post Intensive Care Syndrome HRQoL Health Related Quality of Life eHealth Electronic Health PRISMA Preferred Reporting Items for Systematic reviews and Meta-Analyses PROSPERO Prospective Register of Systematic Review databases MMAT Mixed Methods Appraisal Tool RCT Randomised Controlled Trial TAU Treatment as usual Medical Subject Headings MeSH Declarations Ethics Approval and Consent to Participate Not applicable Consent for Publication Not applicable Competing Interests The author(s) declare no conflicts of interest Funding This paper is funded by the NIHR Applied Research Collaboration Kent, Surrey and Sussex (NIHR ARC KSS) for the author Daniel Lai (DL). The views expressed are those of the author(s) and not necessarily those of the NIHR. Author Contribution All authors were involved with the conceptualisation of the review. DL wrote the draft and main manuscript. DL, ZL, and TD contributed to the article screening and inclusions. DL and ZL did data extraction independently with oversight from SS and TD. EJ, LD, SS, and TD provided critical feedback when reviewing and revising the manuscript. All authors reviewed the manuscript. All authors have read and approved the final manuscript. Data Availability Supplementary materials are provided and can be assessed online. References LaBuzetta JN, Rosand J, Vranceanu AM. post-intensive care syndrome: unique challenges in the neurointensive care unit. Neurocritical care. 2019;31(3):534–45. Zimmerman JE, Kramer AA, Knaus WA. Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Critical care. 2013; 17:1–9. 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Supplementary Files SupplementaryMaterialDatabaseSearchStrategies.docx SupplementaryMaterialRiskofBiasratings.docx Cite Share Download PDF Status: Published Journal Publication published 27 Sep, 2024 Read the published version in Critical Care → Version 1 posted Editorial decision: Revision requested 27 Jul, 2024 Reviews received at journal 25 Jul, 2024 Reviews received at journal 23 Jul, 2024 Reviewers agreed at journal 18 Jul, 2024 Reviewers agreed at journal 08 Jul, 2024 Reviewers invited by journal 28 Jun, 2024 Editor assigned by journal 25 Jun, 2024 Submission checks completed at journal 25 Jun, 2024 First submitted to journal 24 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Within the UK, hospital mortality dropped from 55\\u0026ndash;32% between 1988\\u0026ndash;2019 due to a myriad of factors, including increased bed capacity, faster recognition of sepsis, better pre- and in- critical care management \\u003csup\\u003e[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]\\u003c/sup\\u003e. Despite improved outcomes, there are a new set of challenges, with Post Intensive Care Syndrome (PICS) being increasingly recognised as an urgent problem among critical care survivors \\u003csup\\u003e[\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]\\u003c/sup\\u003e. PICS is characterised as a sequalae of new or worsened physical, psychological, and cognitive impairments after critical illness which may persist beyond the critical care setting \\u003csup\\u003e[\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]\\u003c/sup\\u003e. Approximately 25\\u0026ndash;55% of patients discharged from the critical care units will experience one or more of these impairments which can include pain, muscle weakness, sleep disturbances, issues with memory and attention, depression, anxiety, and Post Traumatic Stress Disorder \\u003csup\\u003e[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]\\u003c/sup\\u003e. PICS can persist for over 10 years post-discharge and has significant impacts on functional outcomes \\u003csup\\u003e[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]\\u003c/sup\\u003e, Health-Related Quality of Life (HRQoL) \\u003csup\\u003e[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]\\u003c/sup\\u003e, and employment \\u003csup\\u003e[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]\\u003c/sup\\u003e. Thus, the establishment of a rehabilitation pathway is essential for successful PICS management.\\u003c/p\\u003e \\u003cp\\u003eCritical care rehabilitation consists of four phases: acute recovery and prevention within the critical care unit, recovery in the hospital ward, the first 3 months after hospital discharge termed the early post-discharge period, and the late post-discharge period which can span years after discharge \\u003csup\\u003e[\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/sup\\u003e. Our review terms the three phases after critical care discharge as the \\u0026lsquo;post-critical care\\u0026rsquo; phases. The effectiveness of current interventions in the post-critical care phases are limited with most targeting the late post-discharge period \\u003csup\\u003e[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]\\u003c/sup\\u003e. This limited effectiveness could be due to the timepoints chosen to begin rehabilitation (i.e., a later start of rehabilitation). The early post-discharge period is deemed a crucial recovery point where critical care survivors are most vulnerable. Despite the relevance of the initial phase of recovery post-hospital discharge, survivors are often restricted to the care and support of their General Practitioners. In the UK, not all critical care teams provide specialist follow-up clinics at the two-to-three-month time point after hospital discharge as \\u003cem\\u003eper\\u003c/em\\u003e recommendations by the National Institute for Health and Care Excellence guidelines \\u003csup\\u003e[\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]\\u003c/sup\\u003e. During the critical period between the hospital discharge and the 3-month follow-up appointment and in the absence of rehabilitation, PICS impairments may develop or worsen. These adverse impacts are further magnified by regional health inequalities due to their physical ability to access care, geographical location, and available local community resources \\u003csup\\u003e[\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]\\u003c/sup\\u003e. Thus, there is a need for an earlier intervention and a continuity of care to improve patient outcomes of PICS recovery.\\u003c/p\\u003e \\u003cp\\u003eThe use of electronic Health (eHealth) technologies is presented by the literature as a solution to minimise health inequalities and facilitate earlier intervention. eHealth technologies are characterised by 1) enabling the storage, retrieval, and transmission of data, 2) supporting clinical decision making, and 3) to facilitate remote care \\u003csup\\u003e[\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]\\u003c/sup\\u003e. These technologies include mobile applications, video conferencing, virtual reality, web platforms and wearable technology. eHealth solutions aim to offer improved patient care in a cost-effective manner and has been shown to improve access to care, quality of life and disease management \\u003csup\\u003e[\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eThe importance of eHealth and its relevance in healthcare was highlighted during the COVID-19 pandemic. With the demand of critical care services sharply rising, critical care across the globe had to adapt by embracing a tele-critical care model. The scaling up and usage of technology enabled reduced direct contact with COVID-19 patients \\u003csup\\u003e[\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]\\u003c/sup\\u003e. Even in a post-pandemic world, tele-critical care provides additional benefits such as addressing workforce shortages, better access to specialist expertise, reduced patient transfers, lower ICU-mortality, and length of stay \\u003csup\\u003e[\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]\\u003c/sup\\u003e. eHealth interventions can increase access to care and enables opportunities for critical care teams to foster better PICS recovery by starting rehabilitation treatment earlier.\\u003c/p\\u003e \\u003cp\\u003eThough the use of eHealth technologies has proliferated within critical care, efforts in harnessing the benefits of eHealth have only just begun in a post-critical care setting. Evidence from other chronic patient populations like heart failure, stroke and diabetes have shown promising results in eHealth\\u0026rsquo;s effectiveness on post-hospital disease management, medicine adherence, and health related quality of life \\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR21\\\" citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]\\u003c/sup\\u003e. However, specific identification and evaluation in a post-critical care setting is required due to the context-dependence of eHealth intervention uptake \\u003csup\\u003e[\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eStudies conducted in the last 3 years demonstrate a demand for tools that can detect and measure rehabilitation of PICS symptoms \\u003csup\\u003e[\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]\\u003c/sup\\u003e. The use of eHealth interventions to rehabilitate patients in the early post-discharge phase could promote better PICS recovery. To our knowledge, this is the first comprehensive review of eHealth\\u0026rsquo;s impact on PICS outcomes during the critical care rehabilitation phase. This encompasses the in-hospital, early, and late post-discharge phases. The objective of the review is to identify effective strategies using eHealth that target PICS, their timeline in the recovery path and the outcomes addressed. As primary outcomes, we consider the PICS domains (physical, psychological and cognitive) targeted by the eHealth interventions, the recovery phase these interventions are implemented and their effectiveness. Secondary objectives include the feasibility of these eHealth interventions and identification of the barriers, and facilitators that encourage the uptake of eHealth interventions.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eThis systematic review is reported based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) \\u003csup\\u003e[\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]\\u003c/sup\\u003e. The study was registered and published into the International Prospective Register of Systematic Review databases (PROSPERO registration number: CRD42023463036) \\u003csup\\u003e[\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSearch Strategy and Selection Criteria\\u003c/h2\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eSearch Strategy\\u003c/h2\\u003e \\u003cp\\u003eThe following databases were searched: Medline, CINAHL, PsycINFO, Embase, and Scopus. Reference lists from key articles were also checked for any additional articles that fit the inclusion criteria. Due to the rapid innovation of eHealth technologies, studies that were published from 30th January 2010 to 12th February 2024 were included in this review. No restrictions were imposed on the language of publication.\\u003c/p\\u003e \\u003cp\\u003eThe PICO framework \\u003csup\\u003e[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]\\u003c/sup\\u003e was used to identify key terms and develop the search string. Since the comparator category is not relevant for this review, PIO was used. The categories were defined as (P): Post Intensive Care patients; (I): eHealth interventions; (O) Post Intensive Care Syndrome outcomes (Physical, Psychological, Cognitive). The Medline search string was (eHealth OR e-health OR mhealth OR tele-health OR telemedicine OR remote monitoring OR remote patient monitoring OR Wearable monitors OR physiological monitoring OR Virtual Reality) AND (Intensive Care Unit OR ICU OR Critical care OR critical care survivor* OR post intensive care discharge OR post-ICU OR Post Intensive Care Syndrome OR PICS) AND (Physical function OR ICU-acquired weakness OR Psychological outcomes OR Depression OR Anxiety OR PTSD OR Cognitive Outcomes OR Memory OR Attention OR executive function). The search string was tailored to fit the querying format of each database and can be found in the Supplementary Material S1.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy Inclusion and Exclusion Criteria\\u003c/h2\\u003e \\u003cp\\u003eEligible studies included i) adults over the age of 18 who have been discharged from critical care (in the hospital ward, early post-discharge, and late post-discharge), ii) the inclusion of one or more eHealth interventions implemented in any of the three phases of post-critical care recovery, iii) PICS domains were measured as an outcome, vi) full text published in peer reviewed journals. There were no restrictions made on the study design and the language of publications. As current eHealth definitions proposed in the literature are very broad and general, we used the definition by Black et al., \\u003csup\\u003e[\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]\\u003c/sup\\u003e to operationalise what constitutes as an eHealth intervention. The eHealth inclusions and exclusion criteria were developed based on this definition and the types of eHealth interventions were categorised in these categories.\\u003c/p\\u003e \\u003cp\\u003e \\u003col\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eTelemedicine\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eTelerehabilitaiton\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eSelf-directed interventions\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eRemote patient monitoring (wearables, sensors)\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eVirtual Reality (VR)\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003c/ol\\u003e \\u003c/p\\u003e \\u003cp\\u003eStudies excluded consisted of i) no evidence of eHealth intervention, ii) Paediatric (children) ICU, iii) neonatal/prenatal ICU, iv) systematic reviews and meta-analyses, v) conference abstracts, and vi) study protocols.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSelection Process\\u003c/h2\\u003e \\u003cp\\u003eTwo reviewers (DL, ZL) independently screened the articles according to the stipulated inclusion and exclusion criteria. During the titles and abstract screening stage, screening procedures proposed by Adams et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e]\\u003c/sup\\u003e were used. The first reviewer (DL) screened all titles and abstracts, while the second reviewer (ZL) screened a 10% random selection of articles. There was substantial inter-rater reliability between the reviewers (Kappa\\u0026thinsp;=\\u0026thinsp;0.66; percentage agreement\\u0026thinsp;=\\u0026thinsp;98.8%). Full-text screening was done independently by DL and ZL with almost perfect agreement (Kappa\\u0026thinsp;=\\u0026thinsp;0.95, percentage agreement\\u0026thinsp;=\\u0026thinsp;98.3%) Any disagreements were be discussed between the two reviewers until consensus was reached. When consensus could not be reached, the dispute was solved with the consultation of a senior team member (TD).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eData Extraction\\u003c/h2\\u003e \\u003cp\\u003eData extracted consisted of study characteristics (Author/year; Country; Study design; Population; Post-critical care timepoint; Sample size/Control (if any); Study duration), eHealth intervention characteristics (Intervention; Type of eHealth intervention; Delivery Format; Findings). Data extraction was done in duplicate by two reviewers (DL and ZL) who worked independently.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eRisk of Bias and Quality Assessment\\u003c/h2\\u003e \\u003cp\\u003eTwo reviewers (DL, and ZL) independently assessed risk of bias and the quality of studies using the Mixed Methods Appraisal Tool (MMAT) \\u003csup\\u003e[\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]\\u003c/sup\\u003e. The tool evaluates mixed method studies and is designed for mixed study systematic reviews. It examines and evaluates the appropriateness of a study\\u0026rsquo;s aims, methodology, design, data collection, data analysis, presentation of findings, discussion, and conclusion. There are four questions regarding quality based on study type (quantitative, qualitative, or mixed method) and each study was scored using percentages based on the recommendations by Pace et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]\\u003c/sup\\u003e. Any disagreements were resolved through discussion between the two reviewers.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eData Synthesis and Analysis\\u003c/h2\\u003e \\u003cp\\u003eA quantitative analysis of outcomes or meta-analysis could not be done due to the heterogeneity of the study designs, outcome measures used, eHealth interventions, and the critical care population. With the included studies, a qualitative narrative synthesis was undertaken to summarise the primary and secondary outcomes of interest. Data were grouped based on the main outcomes listed in the \\u003cspan refid=\\\"Sec7\\\" class=\\\"InternalRef\\\"\\u003edata extraction\\u003c/span\\u003e section.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eInitial database searches yielded 3,673 articles. Deduplication of 428 articles led to a total of 3,245 titles and abstracts screened. In accordance with the exclusion criteria, 3,186 articles were excluded leaving 59 articles for full text retrieval. Out of the 59 articles, 13 met the inclusion criteria for the current review. Figure\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e presents the PRISMA diagram documenting the processes of identifying, screening, and selection of included papers.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy Characteristics\\u003c/h2\\u003e \\u003cp\\u003eA total of 548 participants were enrolled across 13 studies. The sample sizes ranged from 5 to 89 with participant ages ranging from 47 to 72 years. Though the majority of the studies reported mature adults above 50 years of age, there is great variation in the average age across studies. Three studies had a mean age of below 50 \\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]\\u003c/sup\\u003e, 5 studies had a mean participant age below 62 \\u003csup\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]\\u003c/sup\\u003e, and 3 studies had mean participant age below 73 \\u003csup\\u003e[\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e]\\u003c/sup\\u003e. Study design varied considerably across the studies with 46% (6/13) of studies being Randomised Controlled feasibility Trials (RCT) \\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR32\\\" citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]\\u003c/sup\\u003e, 38.4% (5/13) prospective observational cohort studies \\u003csup\\u003e[\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e]\\u003c/sup\\u003e, and 15.3% (2/13) qualitative studies looking at the acceptability and experiences of a telemedicine program and eHealth application \\u003csup\\u003e[\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]\\u003c/sup\\u003e. Studies were conducted across 7 countries with majority coming from the United States (6/13). The characteristics and intervention descriptions of included studies are summarised in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eStudy characteristics, description of eHealth interventions and main findings.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"11\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c11\\\" colnum=\\\"11\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAuthor, Year\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCountry\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eStudy Design\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ePopulation\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eTime\\u003c/p\\u003e \\u003cp\\u003epoint\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eSample/Control\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eDuration\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eIntervention\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eType of eHealth intervention\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eDelivery format\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003eMain Findings\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBalakrishnan et al., 2023\\u0026nbsp;\\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eFeasibility RCT\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCovid-19 patients\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eEarly post-discharge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e40/\\u003c/p\\u003e \\u003cp\\u003eTAU\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e10 weeks\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTelemedicine visits 14 days post-hospital discharge in Covid-19 and ARDS survivors.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eTelemedicine/ Video call\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eVideo\\u003c/p\\u003e \\u003cp\\u003ecall\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e\\u0026bull; No significant difference in HRQOL, and anxiety.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Feasibility and acceptability concluded.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; 75% of participants continued using provided pulse oximeter and Blood pressure monitor after study\\u0026rsquo;s conclusion.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCapin et al., 2022\\u0026nbsp;\\u003csup\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eFeasibility RCT\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCovid-19 patients\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eEarly post-discharge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e44/\\u003c/p\\u003e \\u003cp\\u003eActive\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e12 weeks\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTelerehabilitation program which included 12 exercise sessions led by a physiotherapist.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eTele-rehabilitation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eApp\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e\\u0026bull; No significant difference in physical outcomes.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; No significant difference in cognitive outcomes.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Feasibility and safety concluded 83% met 100% adherence.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCox et al., 2019\\u0026nbsp;\\u003csup\\u003e[\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eFeasibility RCT\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eMedical, cardiac, and surgical ICU\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eEarly post-discharge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e80/\\u003c/p\\u003e \\u003cp\\u003eActive\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e12 weeks\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eSelf-directed mindfulness application which delivered 4 mindfulness sessions consisting of background videos, guided meditation and educational materials\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eSelf-Directed eHealth intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eApp\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e\\u0026bull; Mindfulness group has lower PTSD and Depressive symptoms and anxiety scores compared to group that received education.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Feasibility, acceptability, and usability concluded.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; 71% adherence in intervention group.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Acceptability measure exceeded benchmark scores (M\\u0026thinsp;=\\u0026thinsp;27.6, SD\\u0026thinsp;=\\u0026thinsp;3.8).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDenehy et al., 2012\\u0026nbsp;\\u003csup\\u003e[\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAustralia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eObservationalQuasi-experimental\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eMedical ICU\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eIn-hospital\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e53\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1 week\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eCritical care survivors wore an actigraph for 7 days at 2 months post-hospital discharge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eRemote patient monitoring\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eWearable\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e\\u0026bull; Absence of chronic disease was significantly associated with increased distance walked (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.000) where chronic disease explained 33.5% of the variance in average distance walked.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; ICU survivors were inactive when quantitatively measured at 2 months after hospital discharge.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; 63% of participants did not reach 30 minutes of moderate physical activity.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEstrup et al., 2019\\u0026nbsp;\\u003csup\\u003e[\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDenmark\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eObservationalQuasi-experimental\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eMedical, surgical ICU\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eIn-hospital\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e44\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003cp\\u003eweek\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eActivity levels measured for 7 days in-hospital. Physical function outcomes were measured 3 months post-hospital discharge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eContinuous patient monitoring\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eWearable\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e\\u0026bull; Improved physical function in most patients 3-month post-hospital discharge.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Physical function correlated with mean daily activity (p\\u0026thinsp;=\\u0026thinsp;0.017), maximum activity on second day (p\\u0026thinsp;=\\u0026thinsp;.0053), and total activity in the daytime (p\\u0026thinsp;=\\u0026thinsp;0.0058).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eJackson et al., 2012\\u0026nbsp;\\u003csup\\u003e[\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eFeasibility RCT\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eMedical, surgical ICU\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eEarly post-discharge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003cp\\u003e/TAU\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e12 weeks\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eA hybrid cognitive, physical and functional rehabilitation. physical and functional rehabilitation sessions were conducted via video call. Cognitive rehabilitation was done in-person\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eTele-rehabilitation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eVideo call\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e\\u0026bull; Improvements in cognitive outcomes.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Improvements in instrumental activities of daily living (driving, shopping).\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Feasibility concluded.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; 76.9% adherence to intervention.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKovaleva et al., 2023\\u0026nbsp;\\u003csup\\u003e[\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eICU Sepsis and/or ARDS diagnosis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eLate post-discharge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e12 weeks\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eVideo conference at 3- and 12- weeks post hospital discharge.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eTelemedicine\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eVideo call\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e\\u0026bull; All participants found telemedicine visit acceptable.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Technology was easy to use.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Reassured about mental health status.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Ways to improve intervention include\\u003c/p\\u003e \\u003cp\\u003e1. Increase visit frequency\\u003c/p\\u003e \\u003cp\\u003e2. Schedule visit sooner\\u003c/p\\u003e \\u003cp\\u003e3. Match visit schedules with individual recovery trajectories\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePark et al., 2023\\u0026nbsp;\\u003csup\\u003e[\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eObservational Quasi-experimental\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCovid-19\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eLate post-discharge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e18\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eUp to 14 sessions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eUp to 14 virtual, evidence-based psychotherapy sessions for patients. Intervention integrated psychoeducation, cognitive restructuring, acceptance, exposure-based, and mindfulness.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eTele-psychotherapy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eVideo call\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e\\u0026bull; Significant decrease in participants meeting anxiety (57.1% decrease) and depression (57.2% decrease).\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Feasibility concluded.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; 77.8% adherence to intervention.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eParker et al., 2020\\u0026nbsp;\\u003csup\\u003e[\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAustralia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eARDS survivors\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eLate post-discharge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eN. A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eApplication which consisted of educational resources on rehabilitation, a mood tracker, and a goal tracker\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eEducational\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eApp\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e\\u0026bull; 80% stated application was easy to use.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; 37% stated it would be helpful to have an application demonstration.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Median score for app \\u0026lsquo;helpfulness\\u0026rsquo; was the maximum score of 5, IQR [4.24-5.00].\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRose et al., 2021\\u0026nbsp;\\u003csup\\u003e[\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUK\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eObservational\\u003c/p\\u003e \\u003cp\\u003eQuasi-experimental\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eMedical, Surgical ICU\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eEarly post-discharge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e12 weeks\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eDelivered through online/mobile platform. The platform provided assessments of baseline status and recovery barriers, tailored e-resources based on recovery barriers, patient recovery e-diary.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eTelemedicine\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eWeb-based/\\u003c/p\\u003e \\u003cp\\u003eApp\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e\\u0026bull; Two patients reported achieving short-term goals, 2 partially achieved goals, and 1 did not achieve.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVlake et al., 2021\\u003c/p\\u003e \\u003cp\\u003e\\u003csup\\u003e[\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNetherlands\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eMulti-centre feasibility RCT\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eICU\\u003c/p\\u003e \\u003cp\\u003eSepsis or septic shock diagnosis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eIn-hospital\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e50/\\u003c/p\\u003e \\u003cp\\u003eActive\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003cp\\u003esession\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003ePatients in the stepdown ward go through the ICU-VR intervention which includes different scenes in the ICU unit. Patients were then followed up 2 days, 1 week, 1 month, and 6 months after VR intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eVirtual Reality intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eVirtual Reality headset\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e\\u0026bull; PTSD and depression reduced in VR intervention group 2 days after exposure and persisted throughout follow up timepoints\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; HRQoL improved in VR intervention group up to 1 month after VR intervention. Did not improve 6 months after intervention\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; VR intervention group experienced greater sense of presence, involvement and experienced realism\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVlake et al., 2022 \\u003csup\\u003e[\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNetherlands\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eMulti-centre feasibility RCT\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCovid-19\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eLate post-discharge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e89/\\u003c/p\\u003e \\u003cp\\u003eTAU\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003cp\\u003esession\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eVR intervention is the same as intervention above but was trialed on a post-hospital discharge sample. Participants were followed up 1 and 3 months after 3-month post-icu clinic appointment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eVirtual Reality intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eVirtual Reality headset\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e\\u0026bull; Psychological outcomes and quality of life did not improve\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Feasibility and acceptability concluded\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Satisfaction in ICU aftercare rated higher in intervention group\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; 100% recommended the intervention to other patients\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; 100% adherence to 6-month follow-up\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWood et al., 2018\\u0026nbsp;\\u003csup\\u003e[\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCanada\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eObservational Quasi-experimental\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eMedical, Surgical ICU\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eLate\\u003c/p\\u003e \\u003cp\\u003epost-discharge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e70\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e2 sessions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eA screening tool where participants completed 7 tasks within a VR environment.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eVirtual Reality Screening Tool\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eVirtual Reality\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e\\u0026bull; Prevalence of cognitive and sensorimotor impairments 9/28 (32%) and 3/22 (14%) participants displayed global cognitive impairment.\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Screening tool caused little to no procedural discomfort\\u003c/p\\u003e \\u003cp\\u003e\\u0026bull; Provides additional sensorimotor function metrics than pen and paper testing cannot capture\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"11\\\"\\u003e\\u003cem\\u003eRCT\\u003c/em\\u003e Randomised Controlled Trial, \\u003cem\\u003eTAU\\u003c/em\\u003e Treatment as usual, \\u003cem\\u003eHRQoL\\u003c/em\\u003e Health Related Quality of Life, \\u003cem\\u003ePTSD\\u003c/em\\u003e Post Traumatic Stress Disorder, \\u003cem\\u003eICU\\u003c/em\\u003e Intensive Care Unit, \\u003cem\\u003eM\\u003c/em\\u003e Mean, \\u003cem\\u003eSD\\u003c/em\\u003e Standard Deviation, \\u003cem\\u003eARDS\\u003c/em\\u003e Acute Respiratory Distress Syndrome, \\u003cem\\u003eVR\\u003c/em\\u003e Virtual Reality\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e--------------------------------\\u003cb\\u003eInsert\\u003c/b\\u003e Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e \\u003cb\\u003ehere (Page 11- Page 20)\\u003c/b\\u003e ---------------------------\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eInterventions Targeting PICS\\u003c/h2\\u003e \\u003cp\\u003eThere were a wide range of different eHealth interventions and delivery formats. 3 studies reported on telerehabilitation \\u003csup\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]\\u003c/sup\\u003e, 2 studies looked at telemedicine \\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]\\u003c/sup\\u003e, 2 studies looked at patient monitoring \\u003csup\\u003e[\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]\\u003c/sup\\u003e, 3 studies looked at virtual reality \\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR42\\\" citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e]\\u003c/sup\\u003e, and 1 study team looked at a self-directed eHealth intervention \\u003csup\\u003e[\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e]\\u003c/sup\\u003e. The format of intervention delivery is associated with the domains that were targeted with the intervention: wearable sensors were associated with physical domains, the video conferencing was associated with physical and cognitive domains, self-help applications were associated with the psychological domain, and virtual reality was associated with psychological and cognitive domains.\\u003c/p\\u003e \\u003cp\\u003eOut of the three domains, eHealth interventions targeted the psychological domain most frequently \\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]\\u003c/sup\\u003e, followed by the physical domain \\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR35\\\" citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]\\u003c/sup\\u003e and the cognitive domain being the least targeted \\u003csup\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e]\\u003c/sup\\u003e.Only three study teams designed interventions that covered two PICS domains \\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]\\u003c/sup\\u003e.There were no eHealth interventions that targeted all three PICS domains in tandem. Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e summarises the relationship between intervention delivery format and domains targeted.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eSummary of targeted PICS domains of each eHealth intervention\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAuthor/Year\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntervention Delivery format\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePhysical\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ePsychological\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eCognitive\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDenehy et al., 2012 \\u003csup\\u003e[\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eWearable sensor\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ex\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEstrup et al.,2019 \\u003csup\\u003e[\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eWearable sensor\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ex\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eJackson et al., 2012 \\u003csup\\u003e[\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eVideo conference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ex\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ex\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCapin et al., 2022 \\u003csup\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eVideo conference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ex\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ex\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBalakrishnan et al., 2023 \\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eVideo conference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ex\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ex\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePark et al., 2023 \\u003csup\\u003e[\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eVideo conference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ex\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCox et al., 2019 \\u003csup\\u003e[\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eApplication\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ex\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRose et al., 2021\\u003csup\\u003e[\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eWeb/Application\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ex\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVlake et al., 2021\\u003csup\\u003e[\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eVirtual Reality\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ex\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVlake et al., 2022 \\u003csup\\u003e[\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eVirtual Reality\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ex\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWood et al., 2018 \\u003csup\\u003e[\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eVirtual Reality\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ex\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e\\u003c/h2\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eTiming of Interventions\\u003c/h2\\u003e \\u003cp\\u003eThe included eHealth interventions tackled the three phases of post-critical care rehabilitation. Most of the included studies (5/11 studies) chose the early post discharge phase \\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR32\\\" citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]\\u003c/sup\\u003e. For the other two phases, there were 3 studies \\u003csup\\u003e[\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]\\u003c/sup\\u003e conducted in-hospital and 3 studies during the late post-discharge phase \\u003csup\\u003e[\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e]\\u003c/sup\\u003e. This result emphasizes the emergence of eHealth interventions addressing PICS impairments in the early post-discharge phase. In addition, it also highlights the potential of developing eHealth interventions in the late post-discharge phase to provide longitudinal care management to critical care survivors.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eeHealth Intervention Effects on PICS Outcomes\\u003c/h2\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003ePhysical Outcomes\\u003c/h2\\u003e \\u003cp\\u003eThe impact of eHealth interventions on physical function were mixed. Whilst Jackson et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]\\u003c/sup\\u003e found a significant effect on physical function with a multi-component telerehabilitation, Capin et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]\\u003c/sup\\u003e did not find any significant effects of physical function with a tele-physical therapy intervention. The multi-component intervention attributed its significant effects to the co-delivery of cognitive and physical rehabilitation that the tele-physical therapy intervention did not include.\\u003c/p\\u003e \\u003cp\\u003eA significant improvement in physical function at 3 months post-discharge was significantly correlated with mean daily activity \\u003csup\\u003e[\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]\\u003c/sup\\u003e. An absence of chronic disease is a majorly significant (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;.000) predictor of increased distance walked post-hospital discharge explaining 33.5% of the variance in mean distance walked \\u003csup\\u003e[\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]\\u003c/sup\\u003e. This result reiterates the importance of early rehabilitation in preventing the chronic impairments of PICS and the relevance of interventions targeting multiple domains to optimal rehabilitative effects.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec17\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePsychological Outcomes\\u003c/h2\\u003e \\u003cp\\u003eOf the 6 studies that targeted psychological outcomes, 4 studies showed significant reductions in anxiety \\u003csup\\u003e[\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]\\u003c/sup\\u003e, depression \\u003csup\\u003e[\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]\\u003c/sup\\u003e, and Post Traumatic Stress Disorder \\u003csup\\u003e[\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]\\u003c/sup\\u003e. Only 2 studies showed no effects \\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eA possible reason for having no effects is that Balakrishnan et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]\\u003c/sup\\u003e study used telemedicine to provided care planning for participants rather than active rehabilitation provided by a physiotherapist or psychologist. In contrast, Vlake et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]\\u003c/sup\\u003e did not find significant improvements in psychological outcomes in a late post-discharge sample. However, a prior study conducted by the same authors found an improvement in psychological outcomes 2 days after exposure and persisted across other follow-up timepoints \\u003csup\\u003e[\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]\\u003c/sup\\u003e. There could be a possibility that there is an optimal window for certain interventions to be effective. Overall, the included studies have provided promising results in alleviating psychological PICS symptoms with eHealth interventions.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec18\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eCognitive Outcomes\\u003c/h2\\u003e \\u003cp\\u003eThe two studies that targeted cognitive outcomes used the same telerehabilitation programmes used in the \\u003cspan refid=\\\"Sec16\\\" class=\\\"InternalRef\\\"\\u003ephysical outcomes\\u003c/span\\u003e section \\u003csup\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]\\u003c/sup\\u003e. Similarly, Capin et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]\\u003c/sup\\u003e did not find any improvement in cognitive outcomes while Jackson et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]\\u003c/sup\\u003e found significant improvement in executive functioning. The physiotherapy intervention only focussed on the physical domain and did not have a cognitive rehabilitation component unlike the multi-component intervention. Thus, a direct effect of measured cognitive outcomes would not have been observed. The incorporation of the cognitive domain is still incipient, and more evidence is required to determine eHealth\\u0026rsquo;s impact.\\u003c/p\\u003e \\u003cp\\u003eWood et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e]\\u003c/sup\\u003e tested a cognitive screening assessment using virtual reality. As the primary aim was to report the prevalence of cognitive impairments among survivors, the effects of screening intervention on cognitive outcomes were not evaluated. The study found that less pronounced cognitive impairment at 12 months compared to 3-month follow-up.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec19\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSecondary Outcomes\\u003c/h2\\u003e \\u003cdiv id=\\\"Sec20\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eFeasibility\\u003c/h2\\u003e \\u003cp\\u003eAll the included studies which explored feasibility (9 out of 13 studies) demonstrated feasibility of the various eHealth interventions. All studies had an adherence rate of more than 70%. One study had 71% adherence \\u003csup\\u003e[\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e]\\u003c/sup\\u003e, 4 studies had\\u0026thinsp;\\u0026gt;\\u0026thinsp;75% adherence \\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR35\\\" citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]\\u003c/sup\\u003e, 1 study had 83% adherence \\u003csup\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]\\u003c/sup\\u003e, 1 study had 90% adherence \\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e],\\u003c/sup\\u003e and 2 studies had 100% adherence \\u003csup\\u003e[\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec21\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eAcceptability of eHealth Interventions\\u003c/h2\\u003e \\u003cp\\u003eStudies which reported acceptability included two qualitative studies \\u003csup\\u003e[\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]\\u003c/sup\\u003e and 3 RCTs \\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]\\u003c/sup\\u003e. All studies concluded the intervention to be acceptable. The 3 RCT studies evaluated acceptability using a questionnaire and reported participant satisfaction. Balakrishnan et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]\\u003c/sup\\u003e mentioned that participants felt the telemedicine follow-up clinic provided assurance and that the equipment provided continued to be used even after the study. Vlake et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]\\u003c/sup\\u003e reported that the VR intervention group rated satisfaction with ICU aftercare significantly higher (p\\u0026thinsp;=\\u0026thinsp;.002) with 62% of the participants attributing that satisfaction to the VR intervention. All participants recommended the VR intervention to other ICU survivors.\\u003c/p\\u003e \\u003cp\\u003eThe two qualitative studies focused on the experiences of a telemedicine intervention and an app-based mood monitoring prototype system \\u003csup\\u003e[\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eRegarding the barriers to the use of eHealth interventions, most themes considered the sensitivity of mental health and cognitive issues. Participants felt that labelling psychological impairments without a thorough assessment could affect engagement with the interventions. Participants from Kovaleva et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]\\u003c/sup\\u003e study mentioned that neuropsychological assessments felt \\u0026lsquo;embarrassing\\u0026rsquo; when other clinicians were present in the video call. Participants in Parker et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]\\u003c/sup\\u003e study thought \\u0026lsquo;depression\\u0026rsquo; was too stigmatising and suggested the term emotions/states as an option. It was also mentioned that the tracking of physical health (activity, heart rate etc.) would be beneficial.\\u003c/p\\u003e \\u003cp\\u003eUsability and perceived usefulness were identified as the main facilitators to the use of eHealth interventions. Facilitators in the acceptability of eHealth interventions included the ease of using the intervention platforms, the convenience, and viewing the platform as a motivator of recovery. Telemedicine was proposed as the most feasible option for attending clinics remotely for some participants who may be too weak or unable to drive to the hospital \\u003csup\\u003e[\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]\\u003c/sup\\u003e. With regards to remote monitoring, the system should encompass a rehabilitation programme with achievable goals as well as in-built reward systems to encourage motivation to engage with the intervention.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec22\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eQuality Assessment and Risk of Bias of Included Studies\\u003c/h2\\u003e \\u003cp\\u003eQuality assessments used the MMAT tool (Hong et al., 2018) with most studies running quantitative randomised controlled trials. Though included RCTs varied in quality, most of the studies were of high quality with 4 of 6 studies scoring 80% \\u003csup\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]\\u003c/sup\\u003e and 2 studies scoring 60% \\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]\\u003c/sup\\u003e. The main limitations impacting study quality were due to incomplete outcome data and the inability to \\u0026lsquo;blind\\u0026rsquo; participants. There was a greater variance in study quality for non-randomised quantitative studies with 2 high quality studies scoring 80% \\u003csup\\u003e[\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]\\u003c/sup\\u003e, 2 studies moderate quality studies scoring 60% \\u003csup\\u003e[\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e]\\u003c/sup\\u003e and 1 low quality study scoring 20% \\u003csup\\u003e[\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]\\u003c/sup\\u003e. The main limitations that impacted the low-quality study was the representativeness of the sample, selection of measures, and incomplete description of intervention as intended. The two qualitative studies were high-quality at 80% \\u003csup\\u003e[\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]\\u003c/sup\\u003e and 100% \\u003csup\\u003e[\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]\\u003c/sup\\u003e. The detailed rating and scoring of the MMAT tool can be found in Supplementary Material S2.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eCurrent critical care rehabilitation services demonstrate a lack of evidence for early acute rehabilitation beyond early mobilisation, a deprived access in crucial services like physio or psychological therapy that improves function, and no long-term care planning beyond the 3-month critical care rehabilitation clinic \\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR12 CR13\\\" citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]\\u003c/sup\\u003e. The main objectives of the study were to systematically assess and explore eHealth\\u0026rsquo;s potential in addressing these gaps. Specifically, we evaluated the effectiveness of eHealth interventions in a post-critical care population and identified the PICS domains currently targeted. 3,673 articles were searched across 5 databases and 13 studies met the stipulated inclusion criteria. Most studies were conducted in the early post-discharge phase reflecting the field\\u0026rsquo;s desire to devise interventions to solve these problems. Despite identifying a variety of eHealth interventions, research has yet to consider an intervention that targets all three domains of PICS. Within the post-critical care recovery phases, preliminary results of eHealth\\u0026rsquo;s effectiveness on PICS outcomes were generally positive.\\u003c/p\\u003e \\u003cp\\u003eJackson et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]\\u003c/sup\\u003e attributed significant effects in physical and cognitive outcomes when combining rehabilitation of the two domains together, a result that contrasts with Capin et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]\\u003c/sup\\u003e programme which focussed on physical function only. The potential benefits and synergistic effects of performing physical exercise and cognitive training have been documented in other populations \\u003csup\\u003e[\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e]\\u003c/sup\\u003e. Interrelationships among the three domains are presented through the prevalence of PICS symptom comorbidities. Heesaker et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e]\\u003c/sup\\u003e observed that mental health and cognitive impairment always occur simultaneously with the other two domains. Marra et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]\\u003c/sup\\u003e reported a combination of mental health and cognitive impairment occurring more frequently than other combinations. Kang et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e]\\u003c/sup\\u003e built on those studies and found that 41.1% of critical care survivors with PICS had symptoms in two or more domains with Physical-Mental symptoms being the most prevalent. Our team proposes that rehabilitation should consider the underpinnings of the syndrome, i.e., the co-existence of symptoms across domains. It is the co-delivery of interventions across different domains of PICS that leverages positive health outcomes. To that end, care to all PICS domains in tandem requires a multi-disciplinary approach.\\u003c/p\\u003e \\u003cp\\u003eWe highlighted how current post-critical care research adopts a fragmented view to PICS. In the studies included in this review, physical, psychological, and cognitive domains are not targeted altogether either in rehabilitation interventions or in remote patient monitoring systems, the latter only assessing individual PICS domains. The potential benefits of multi-domain rehabilitation, give rise to the need to develop monitoring systems that can track these outcomes concurrently. Support for such proposal can be found in Parker et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]\\u003c/sup\\u003e where participants expressed the keenness for an option that monitors other aspects of health and recovery (on top of mood). Furthermore, current interrelationships between domains are inferred with prevalence studies. The specific roles each domain plays in PICS recovery have yet to be explored. Therefore, the proposal of a multi-domain intervention warrants remote monitoring systems sensitive in tracking these outcomes. This development aligns with patient centred outcomes, future post-critical care research, and clinical need.\\u003c/p\\u003e \\u003cp\\u003eMost studies point to the feasibility of implementing eHealth interventions. The implementation of eHealth interventions into day-to-day clinical practice have been challenging \\u003csup\\u003e[\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e]\\u003c/sup\\u003e. The decision to adopt an eHealth intervention requires careful management of both patient and staff expectations \\u003csup\\u003e[\\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e]\\u003c/sup\\u003e. Clinicians and hospital staff need to believe that the intervention can improve care and efficiency. They need to be on board, involved, and receive consistent support during the adoption \\u003csup\\u003e[\\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e49\\u003c/span\\u003e]\\u003c/sup\\u003e. The success of eHealth implementation is also determined by patient engagement and uptake. This is especially challenging in older patient populations like critical care survivors. Themes of usability and perceived usefulness highlighted in this review were in line with older patients with chronic conditions \\u003csup\\u003e[\\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e]\\u003c/sup\\u003e, older patients with cancer \\u003csup\\u003e[\\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e51\\u003c/span\\u003e]\\u003c/sup\\u003e, and general older population \\u003csup\\u003e[\\u003cspan citationid=\\\"CR52\\\" class=\\\"CitationRef\\\"\\u003e52\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR53\\\" class=\\\"CitationRef\\\"\\u003e53\\u003c/span\\u003e]\\u003c/sup\\u003e. Critical care survivors were more likely to adhere to eHealth interventions when they are easy to use, convenient and perceived as a motivator towards recovery. The continuous contact between patients and the clinical team through telemedicine visits supported the perceptions of care continuance, thus increasing the perceived usefulness and adherence to eHealth interventions. Despite the alignment with recommendations from research on senior populations, given that only two qualitative studies were included in the review, further research is needed to address the specific barriers and facilitators for eHealth uptake and engagement in the PICS population in general.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec24\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy Limitations\\u003c/h2\\u003e \\u003cp\\u003eOne limitation of this review is the infancy of the current research area. The primary objective of studies included in the review was to assess the feasibility of the intervention resulting in underpowered studies with small samples. Despite the positive effects of eHealth on each PICS domain, the results are preliminary in nature. Nevertheless, the summarised evidence paints a promising picture in the development of eHealth interventions in this population. Future studies need to focus on larger scale RCTs which will provide more insight to intervention effectiveness. The authors of the ICU-VR intervention have progressed to a larger RCT trial \\u003csup\\u003e[\\u003cspan citationid=\\\"CR54\\\" class=\\\"CitationRef\\\"\\u003e54\\u003c/span\\u003e]\\u003c/sup\\u003e in hopes to generate more robust effects of the intervention on PICS outcomes. Other eHealth trials are also underway in this post-critical care phase of recovery \\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR56\\\" citationid=\\\"CR55\\\" class=\\\"CitationRef\\\"\\u003e55\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR57\\\" class=\\\"CitationRef\\\"\\u003e57\\u003c/span\\u003e]\\u003c/sup\\u003e. Thus, whilst eHealth interventions can be concluded to be feasible, conclusions on effectiveness are premature at this point.\\u003c/p\\u003e \\u003cp\\u003eEven though no restriction was imposed on the language and country of article publication, the language used in the search strategy undoubtedly constrained its results. We acknowledge that if the search terms included other languages, other articles could be deemed eligible. This review adhered closely to the PICO framework \\u003csup\\u003e[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]\\u003c/sup\\u003e and search strings were systematically piloted in preliminary searches. The review attempted to be as broad as possible regarding the search strategy and the databases selected. Future research may also benefit from the inclusion of Medical Subject Headings (MeSH) terms to further expand the search.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003e In this systematic review we highlighted the need for incorporating rehabilitation and monitoring systems that target the physical, psychological, and cognitive domains of Post Intensive Care Syndrome. Interventions to address PICS need to be holistic, not isolated to individual domains. Future research should consider the interrelationships between the three domains of PICS to optimise the intervention development. eHealth research and development in post-critical care rehabilitation is still early in its infancy with most studies focusing on feasibility and acceptability. Preliminary results are promising and generally positive in effectiveness with research progressing to larger scale studies to derive more robust conclusions. eHealth is one vital solution in providing access, continuity, and sustainable care in the post-critical care setting.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003e\\u003cb\\u003eICU\\u003c/b\\u003e\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eIntensive Care Unit\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003e\\u003cb\\u003ePICS\\u003c/b\\u003e\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ePost Intensive Care Syndrome\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003e\\u003cb\\u003eHRQoL\\u003c/b\\u003e\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eHealth Related Quality of Life\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003e\\u003cb\\u003eeHealth\\u003c/b\\u003e\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eElectronic Health\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003e\\u003cb\\u003ePRISMA\\u003c/b\\u003e\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ePreferred Reporting Items for Systematic reviews and Meta-Analyses\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003e\\u003cb\\u003ePROSPERO\\u003c/b\\u003e\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eProspective Register of Systematic Review databases\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003e\\u003cb\\u003eMMAT\\u003c/b\\u003e\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eMixed Methods Appraisal Tool\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003e\\u003cb\\u003eRCT\\u003c/b\\u003e\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eRandomised Controlled Trial\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003e\\u003cb\\u003eTAU\\u003c/b\\u003e\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eTreatment as usual\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003e\\u003cb\\u003eMedical Subject Headings\\u003c/b\\u003e\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eMeSH\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e \\u003ch2\\u003eEthics Approval and Consent to Participate\\u003c/h2\\u003e \\u003cp\\u003eNot applicable\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eConsent for Publication\\u003c/strong\\u003e \\u003cp\\u003eNot applicable\\u003c/p\\u003e \\u003c/p\\u003e\\u003cp\\u003e \\u003ch2\\u003eCompeting Interests\\u003c/h2\\u003e \\u003cp\\u003eThe author(s) declare no conflicts of interest\\u003c/p\\u003e \\u003c/p\\u003e\\u003ch2\\u003eFunding\\u003c/h2\\u003e \\u003cp\\u003eThis paper is funded by the NIHR Applied Research Collaboration Kent, Surrey and Sussex (NIHR ARC KSS) for the author Daniel Lai (DL). The views expressed are those of the author(s) and not necessarily those of the NIHR.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eAll authors were involved with the conceptualisation of the review. DL wrote the draft and main manuscript. DL, ZL, and TD contributed to the article screening and inclusions. DL and ZL did data extraction independently with oversight from SS and TD. EJ, LD, SS, and TD provided critical feedback when reviewing and revising the manuscript. All authors reviewed the manuscript. All authors have read and approved the final manuscript.\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003eSupplementary materials are provided and can be assessed online.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eLaBuzetta JN, Rosand J, Vranceanu AM. post-intensive care syndrome: unique challenges in the neurointensive care unit. 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BMC health services research. 2016;16:467\\u0026ndash;79.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWilson J, Heinsch M, Betts D, Booth D, Kay-Lambkin F. Barriers and facilitators to the use of e-health by older adults: a scoping review. BMC public health. 2021;21:1\\u0026ndash;2.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eVlake JH, van Bommel J, Wils EJ, Korevaar TI, Taccone F, Schut AF, Elderman JH, Labout JA, Raben AM, Dijkstra A, Achterberg S. Effect of intensive care unit-specific virtual reality (ICU-VR) to improve psychological well-being in ICU survivors: study protocol for an international, multicentre, randomised controlled trial\\u0026mdash;the HORIZON-IC study. BMJ open. 2022;12(9):e061876.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTuran Z, Topaloglu M, Ozyemisci Taskiran O. Is tele-rehabilitation superior to home exercise program in COVID‐19 survivors following discharge from intensive care unit?‐a study protocol of a randomized controlled trial. Physiotherapy Research International. 2021;26(4):e1920.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLimotai C, Ingsathit A, Thadanipon K, Pattanaprateep O, Pattanateepapon A, Phanthumchinda K, Suwanwela NC, Thaipisuttikul I, Boonyapisit K, Thakkinstian A. Efficacy and economic evaluation of delivery of care with tele-continuous EEG in critically ill patients: a multicentre, randomised controlled trial (Tele-cRCT) study protocol. BMJ open. 2020;10(3):e033195.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eEwens B, Myers H, Whitehead L, Seaman K, Sundin D, Hendricks J. A web-based recovery program (ICUTogether) for intensive care survivors: protocol for a randomized controlled trial. JMIR Research Protocols. 2019;8(1):e10935.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"critical-care\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"cric\",\"sideBox\":\"Learn more about [Critical Care](http://ccforum.biomedcentral.com/)\",\"snPcode\":\"13054\",\"submissionUrl\":\"https://submission.nature.com/new-submission/13054/3\",\"title\":\"Critical Care\",\"twitterHandle\":\"@Crit_Care\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Critical Care, Critical Illness, Critical Care Rehabilitation, Post-Intensive Care Syndrome, eHealth, Digital Health Technologies\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-4632511/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-4632511/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground:\\u003c/h2\\u003e \\u003cp\\u003eIt remains unclear how to optimise critical care rehabilitation outcomes to reduce the constellation of long-term physical, psychological and cognitive impairments known as Post Intensive Care Syndrome (PICS). Possible reasons for poor recovery include access to care and delayed treatment. eHealth could potentially aid in increasing access and provide consistent care remotely. Our review aimed to evaluate the effectiveness of eHealth interventions on PICS outcomes.\\u003c/p\\u003e\\u003ch2\\u003eMethods:\\u003c/h2\\u003e \\u003cp\\u003e Studies reporting eHealth interventions targeting Post Intensive Care Syndrome outcomes, published in Medline, CINAHL, PsycINFO, Embase, and Scopus from 30th January 2010 to 12th February 2024, were included in the review. Study eligibility was assessed by two reviewers and any disagreements were discussed between them or resolved by a third reviewer. Study quality and risk of bias were assessed using the Mixed Method Appraisal Tool. Further to the identification of effective strategies, our review also aimed to clarify the timeline of recovery considered and the outcomes or domains targeted by the interventions.\\u003c/p\\u003e\\u003ch2\\u003eResults:\\u003c/h2\\u003e \\u003cp\\u003eOut of 3,673 articles screened, 13 studies were included in our review. Most studies were conducted in the early post discharge phase (i.e., \\u0026lt; 3 months) and presented preliminary effectiveness of eHealth interventions on physical and psychological outcomes. Despite evidence suggesting an optimisation of rehabilitative effects when multiple domains are targeted in the intervention, research has yet to concurrently target all three domains of PICS. Though the interventions were described as feasible and acceptable in all studies, the lack of robust monitoring systems to track the PICS domain outcomes is indisputable.\\u003c/p\\u003e\\u003ch2\\u003eConclusion:\\u003c/h2\\u003e \\u003cp\\u003e Our systematic review highlighted the promising contributions of eHealth with preliminary support for the feasibility and effectiveness of interventions in the early stages of post-critical care rehabilitation. However, it also highlights the fragmented approach to the concept of PICS. The 3 domains should be viewed as interrelated and not as distinct areas of recovery. Future research needs to investigate an integrative approach to these three domains, explore potential domain interrelationships, consider the challenges associated with large-scale eHealth implementation, and greater use of remote monitoring systems. Despite these challenges, eHealth is a critical solution in providing access, continuity, and sustainable care in the post-critical care setting.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Exploring the effectiveness of eHealth interventions in treating Post Intensive Care Syndrome (PICS) outcomes: a systematic review.\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-07-17 05:40:26\",\"doi\":\"10.21203/rs.3.rs-4632511/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2024-07-27T11:42:34+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2024-07-25T05:14:06+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2024-07-23T07:16:20+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"152640461018924767139816227982198536372\",\"date\":\"2024-07-18T22:55:09+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"145784160559508678595029144431373719048\",\"date\":\"2024-07-08T09:59:58+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2024-06-28T07:46:10+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2024-06-25T12:56:20+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2024-06-25T12:55:39+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Critical Care\",\"date\":\"2024-06-24T23:21:59+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"critical-care\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"cric\",\"sideBox\":\"Learn more about [Critical Care](http://ccforum.biomedcentral.com/)\",\"snPcode\":\"13054\",\"submissionUrl\":\"https://submission.nature.com/new-submission/13054/3\",\"title\":\"Critical Care\",\"twitterHandle\":\"@Crit_Care\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"2b2abf67-da64-4d29-9644-9fce19e4c09c\",\"owner\":[],\"postedDate\":\"July 17th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-09-30T16:03:49+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-4632511\",\"link\":\"https://doi.org/10.1186/s13054-024-05089-6\",\"journal\":{\"identity\":\"critical-care\",\"isVorOnly\":false,\"title\":\"Critical Care\"},\"publishedOn\":\"2024-09-27 15:57:39\",\"publishedOnDateReadable\":\"September 27th, 2024\"},\"versionCreatedAt\":\"2024-07-17 05:40:26\",\"video\":\"\",\"vorDoi\":\"10.1186/s13054-024-05089-6\",\"vorDoiUrl\":\"https://doi.org/10.1186/s13054-024-05089-6\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-4632511\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-4632511\",\"identity\":\"rs-4632511\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}