Impact of early goal-directed mobilization on ICU-acquired weakness: a meta-analysis

Background ICU-acquired weakness (ICU-AW) significantly impairs muscle strength and physical function in critically ill patients. Early mobilization interventions have been increasingly adopted, yet the specific effects of a structured EGDM program on ICU-AW and functional outcomes have not been systematically quantified. This meta-analysis aimed to evaluate the effects of EGDM on ICU-AW, muscle strength, and functional outcomes. Methods PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Viper Information Products (VIP) databases were searched for randomized controlled trials (RCTs) up to November 30, 2025. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2.0. RevMan 5.4 was used for meta-analysis. Subgroup analysis was prespecified by allocation concealment. Results Nine RCTs (907 patients) were included. EGDM reduced ICU-AW [ RR = 0.57, 95% CI (0.33 ~ 0.97), p = 0.04 for the overall effect ; I 2 = 77% , p = 0.002 for heterogeneity], but sensitivity analysis of high-quality trials showed no significant effect [ RR = 0.84, 95% CI (0.48 ~ 1.46), p = 0.54 for the overall effect]. EGDM improved muscle strength [ MD = 4.94, 95% CI (3.39 ~ 6.50), I 2 = 59%, p = 0.02 for heterogeneity], shortened the duration of mechanical ventilation [ MD = −81.95 h, 95% CI (−115.45 ~ −48.46), p < 0.00001 for the overall effect; I 2 = 85%, p < 0.00001 for heterogeneity], and reduced ICU stay[ MD = -4.55 days, 95% CI (−6.22 ~ −2.89), p < 0.00001 for the overall effect; I 2 = 74%, p = 0.0004 for heterogeneity], both with substantial heterogeneity. Although the primary Barthel Index analysis was not statistically significant, sensitivity analysis suggested improvement in patients with moderate baseline function [ MD = 8.27, 95% CI (5.66 ~ 10.87), p < 0.00001 for the overall effect]. Conclusion EGDM may improve muscle strength and physical function in ICU patients. The available evidence does not confirm a reduction in ICU-AW. The effects on ventilation duration and ICU stay varied substantially across studies, likely influenced by sedation protocols, weaning practices, and other context-specific factors. Further rigorous trials with detailed reporting of interventions and contextual factors are needed to guide precise clinical implementation. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261280603 , CRD420261280603.