{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:53:29Z","timestamp":1789487609323,"version":"build-2803163510"},"reference-count":42,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,9,15]]},"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Whether integrated rehabilitation strategies spanning intensive care unit (ICU), hospital, and postdischarge phases improve quality of life after acute respiratory failure is uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the effect of an integrated multicomponent telehealth-based rehabilitation intervention on health-related quality of life at 90 days after hospital discharge among adults with acute hypoxemic respiratory failure requiring invasive mechanical ventilation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This stepped-wedge cluster randomized clinical trial in ICUs of 20 public hospitals in Brazil enrolled adults with acute hypoxemic respiratory failure requiring invasive mechanical ventilation between June 2024 and May 2025, with follow-up through September 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>A multicomponent telehealth-based rehabilitation program integrating an ICU telehealth-based rehabilitation intervention focused on ventilator liberation; a ward telehealth-based rehabilitation intervention targeting risk stratification and initiation of individualized rehabilitation plans; and a postdischarge telehealth-based rehabilitation intervention consisting of a 2-month personalized centralized telerehabilitation program.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Health-related quality of life at 90 days after hospital discharge, measured using the EuroQol 5-Dimension 3-Level (EQ-5D-3L) utility score (range, \u22120.17 [worse than death] to 1 [best health state], with 0 representing death).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1916 enrolled patients (mean [SD] age, 60.6 [17.3] years; 43.6% female), 1063 were assigned to the intervention and 853 to usual care per local protocols. At 90 days after hospital discharge, mean (SD) EQ-5D-3L utility scores were higher in the intervention group than in the usual care group (0.16 [0.31] vs 0.12 [0.28]; adjusted difference, 0.049; 95% CI, 0.0002 to 0.098;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.04) but did not differ among survivors (0.60 [0.32] vs 0.59 [0.32]; adjusted difference, \u22120.045; 95% CI, \u22120.138 to 0.045;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.34). Compared with usual care, the intervention resulted in lower 90-day all-cause mortality (71.8% [676 of 941] vs 78.3% [584 of 746]; adjusted difference, \u22127.6%; 95% CI, \u221214.7% to \u22120.6%;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.03) and shorter mean (SD) mechanical ventilation duration (9.9 [10.3] vs 15.5 [15.9] days; adjusted difference, \u22126.2 days; 95% CI, \u22128.5 to \u22123.9;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this study, an integrated telehealth-based rehabilitation strategy delivered across ICU, hospital, and postdischarge phases improved 90-day health-related quality of life, potentially influenced by reduced mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov Identifier:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT06343545\">NCT06343545<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jama.2026.10617","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T15:30:30Z","timestamp":1781105430000},"page":"939","source":"Crossref","is-referenced-by-count":2,"title":["Integrated Telehealth Rehabilitation and Quality of Life in Mechanically Ventilated Adults"],"prefix":"10.1001","volume":"336","author":[{"given":"Regis Goulart","family":"Rosa","sequence":"first","affiliation":[{"name":"Research Projects Office, Hospital Moinhos de Vento Hospital, Porto Alegre, Brazil"},{"name":"Programa de P\u00f3s-Gradua\u00e7\u00e3o em Ci\u00eancias Pneumol\u00f3gicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil"},{"name":"Scientific Committee, Brazilian Research in Intensive Care Network (BRICNet), S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael Barberena","family":"Moraes","sequence":"additional","affiliation":[{"name":"Programa de P\u00f3s-Gradua\u00e7\u00e3o em Ci\u00eancias Pneumol\u00f3gicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil"},{"name":"Scientific Committee, Brazilian Research in Intensive Care Network (BRICNet), S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geraldine","family":"Trott","sequence":"additional","affiliation":[{"name":"Research Projects Office, Hospital Moinhos de Vento Hospital, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maura Cristina","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Einstein Hospital Israelita, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline Paula","family":"Miozzo","sequence":"additional","affiliation":[{"name":"Research Projects Office, Hospital Moinhos de Vento Hospital, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Andrade","sequence":"additional","affiliation":[{"name":"Einstein Hospital Israelita, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer Menna Barreto","family":"de Souza","sequence":"additional","affiliation":[{"name":"Research Projects Office, Hospital Moinhos de Vento Hospital, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana","family":"Wanderley","sequence":"additional","affiliation":[{"name":"Einstein Hospital Israelita, S\u00e3o Paulo, 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