Telehealth Rehabilitation and Quality of Life After Mechanical Ventilation

Key Takeaways

• An integrated telehealth rehabilitation strategy was associated with higher quality-of-life utility at 90 days after discharge.
• Mortality, ventilation duration, days alive and free of hospital, and ordinal clinical status also moved in a more favorable direction with the intervention.
• Survivor-only quality-of-life scores were not significantly different, and program delivery was partial but substantial across ICU, ward, and postdischarge phases.

In adults with acute hypoxemic respiratory failure requiring invasive mechanical ventilation, an integrated telehealth rehabilitation program was associated with a higher 90-day EQ-5D-3L utility score than usual care. In the randomized clinical trial in JAMA, scores were 0.16 vs 0.12, with an adjusted difference of 0.049 (95% CI, 0.0002 to 0.098; P=.04).

Researchers used a stepped-wedge cluster randomized design across 20 public hospitals in Brazil, enrolling adults between June 2024 and May 2025 with follow-up through September 2025. Baseline enrollment totaled 1916 patients, with 1063 assigned to intervention and 853 to usual care, while the primary analysis included 1687 patients with outcome data. The program was embedded in a quality improvement initiative and combined ICU telehealth-supported liberation-focused care, ward screening with individualized planning, and a 2-month centralized telerehabilitation phase. SARS-CoV-2 infection was part of the differential diagnosis, but confirmed COVID-19 was not required. Randomization was stratified by ICU bed number with concealed allocation, and the primary endpoint was EQ-5D-3L utility 90 days after discharge.

Among survivors, EQ-5D-3L utility results were 0.60 vs 0.59, with an adjusted difference of −0.045 (95% CI, −0.138 to 0.045; P=.34). Investigators said the overall quality-of-life separation appeared to track mainly with lower mortality rather than higher survivor-only recovery scores. Ninety-day all-cause mortality was 71.8% vs 78.3%, with an adjusted difference of −7.6% (95% CI, −14.7% to −0.6%; P=.03). Mean mechanical ventilation duration was 9.9 vs 15.5 days, with an adjusted difference of −6.2 days (95% CI, −8.5 to −3.9; P<.001). Days alive and free of hospital within 90 days were 17.4 vs 12.2, with an adjusted difference of 4.9 days (95% CI, 0.2 to 9.6; P=.03). The 9-level clinical status scale also favored the intervention, with an odds ratio of 0.73 (95% CI, 0.55 to 0.97; P=.03).

Thirty-day rehospitalization did not differ significantly, and anxiety, depression, cognitive impairment, instrumental ADL disability, physical dependence, and return to work also did not differ significantly at 90 days. Mean implementation fidelity was 69.6%, with ICU adherence at 80.4%, ward participation at 65.0%, and postdischarge participation at 61.8%. Among ICU survivors meeting rehabilitation criteria, 89.7% attended at least one ward session and 74.0% attended at least one postdischarge session. Ward sessions used study-provided smartphones, and 22.2% of postdischarge-eligible survivors required a study-provided device.