Effect of an internet-based, mobile terminal-supported, family-participatory early rehabilitation model on sleep improvement and stigma prevention in critically ill patients: A randomized controlled trial.
An internet-based, family-participatory early rehabilitation model significantly improves sleep architecture, reduces perceived social stigma, and alleviates procedural pain in critically ill patients, representing a promising non-pharmacological strategy to enhance recovery in the ICU.
Key Findings
Results
The IFPER group demonstrated a significantly greater improvement in sleep efficiency compared to the standard care group.
Mean difference in sleep efficiency improvement was 15.8% (95% CI, 12.5%-19.1%; P < 0.001)
Sleep efficiency was measured by polysomnography (PSG) from baseline to ICU discharge
204 adult ICU patients were randomized; 196 completed the study (102 per group at enrollment)
The IFPER intervention involved trained family members conducting rehabilitation activities guided by a mobile application in addition to standard care
Results
The IFPER group showed a higher percentage of REM sleep and fewer arousals compared to the standard care group.
Differences in REM sleep percentage and arousal frequency were statistically significant (P < 0.01)
These outcomes were measured using polysomnography (PSG)
These findings indicate improvements in sleep architecture beyond simple sleep efficiency
Results
Patients in the IFPER group had significantly lower Social Stigma in Critical Illness (SSCI) scores compared to standard care patients.
SSCI scores were 25.4 ± 5.1 in the IFPER group versus 38.2 ± 6.3 in the standard care group (P < 0.001)
Lower SSCI scores indicate less perceived illness-related stigma
This was a pre-specified secondary outcome of the trial
Results
The IFPER group had consistently lower procedural pain scores throughout the ICU stay.
Procedural pain differences were statistically significant (P < 0.05)
Pain was assessed using the Numeric Rating Scale (NRS) or Critical-Care Pain Observation Tool (CPOT), depending on patient communicative ability
Pain scores were recorded daily as a secondary outcome
Methods
The study was designed as a single-center randomized controlled trial enrolling 204 adult ICU patients assigned to IFPER or standard care.
Patients were randomized 1:1 to IFPER (n = 102) or standard care (n = 102)
196 patients completed the study, indicating a low dropout rate
The primary outcome was change in sleep efficiency from baseline to ICU discharge measured by polysomnography
Secondary outcomes included other PSG parameters, SSCI scores, and daily procedural pain scores
What This Means
This research suggests that involving family members in structured rehabilitation activities guided by a smartphone application can meaningfully improve recovery for patients in intensive care units (ICUs). In a randomized controlled trial of 196 ICU patients, those whose family members participated in a guided rehabilitation program slept significantly better — with nearly 16% higher sleep efficiency and more restorative REM sleep — compared to patients receiving standard care alone. Sleep was measured objectively using polysomnography, a gold-standard method that monitors brain waves and body functions during sleep.
Beyond sleep, patients in the family-participatory program also reported feeling far less social stigma related to their critical illness, scoring notably lower on a stigma scale (25.4 vs. 38.2 out of a possible range), and they experienced less pain during medical procedures throughout their ICU stay. These benefits were achieved without additional medications, relying instead on trained family members following a mobile app-guided protocol alongside standard medical care.
This research suggests that structured, technology-supported family involvement in ICU rehabilitation could be a practical, non-drug approach to improving multiple aspects of patient wellbeing — including sleep, psychological burden, and pain — during a period that is often physically and emotionally difficult. The findings highlight the potential value of integrating family members as active participants in critical care recovery programs.
Liu X, Wang Y, Zheng L, Li D, Wang X, Yang H, et al.. (2026). Effect of an internet-based, mobile terminal-supported, family-participatory early rehabilitation model on sleep improvement and stigma prevention in critically ill patients: A randomized controlled trial.. Sleep medicine. https://doi.org/10.1016/j.sleep.2026.108773