Social connectivity and post-ICU recovery: a scoping review protocol

Abstract

Introduction

Survivors of intensive care unit (ICU) admission and their families frequently experience persistent physical, cognitive and psychological impairments following critical illness, collectively described as post-intensive care syndrome (PICS) and post-intensive care syndrome-family (PICS-F). These sequelae often emerge during the recovery period after hospital discharge and may affect long-term functioning and quality of life. Social connectivity—the extent to which individuals maintain meaningful social relationships and supportive interactions—has been associated with improved health outcomes in several populations. This scoping review aims to map the existing literature describing social connectivity among ICU survivors and their families and examine how it has been studied in relation to recovery outcomes.

Methods and analysis

This scoping review will be conducted using the Joanna Briggs Institute methodology for scoping reviews and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. MEDLINE, EMBASE, CINAHL and PsycINFO will be searched from database inception to December 2025 without language restrictions. Studies examining social connectivity in relation to PICS or PICS-F among adult ICU survivors or their family members will be included. Data will be extracted independently using a standardised charting form and summarised descriptively.

Ethics and dissemination

Ethical approval is not required because this study synthesises previously published literature. Findings will be disseminated through publication in a peer-reviewed journal and may inform future research and patient- and family-centred strategies to support recovery after critical illness.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• This scoping review includes intensive care unit (ICU) survivors, their families/caregivers and families/caregivers of ICU non-survivors, broadening understanding of post-intensive care syndrome (PICS)/PICS-family.

• The review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute methodological guidance, ensuring rigour and transparency.

• A multidisciplinary team—including clinicians, a medical librarian and patient partners—guided protocol development.

• Heterogeneity in definitions and measurement of social connectivity may limit comparability across studies.

• As a scoping review, this study does not assess the quality of included evidence.

Introduction

Recovery from critical illness is shaped by numerous patient-level factors, including pre-existing comorbidities, social determinants of health and psychosocial circumstances. An important but historically underappreciated aspect of the critical illness experience and subsequent recovery is the presence and quality of social support. Before, during and after intensive care unit (ICU) admission, social supports and family presence have been shown to impact mental health and overall functional outcomes for both patients, their family and caregivers. Falvey et al identified an association between social isolation prior to ICU admission and increased burden of disability in older patients following ICU discharge.¹ Importantly, the impact of critical illness extends beyond the patient, placing substantial emotional and psychological strain on family members and informal caregivers. In a prospective observational study by Cameron et al, 43% of caregivers for ICU survivors reported depressive symptoms at 1 year after ICU discharge.² Studies investigating the effects of flexible visitation hours in the ICU on family mental health have demonstrated overall improvements in family members’ well-being, with some reporting reductions in symptoms of depression or anxiety,³ while others have shown improvements primarily in post-traumatic stress symptoms.⁴

Social connectivity is a measure that can be used to define the quality and quantity of an individual’s social interactions, as well as their ability to develop and maintain these relationships.⁵ Poor social connectivity is often described in the literature as social isolation and loneliness.^{6 7} Social isolation and loneliness have been associated with higher mortality,^{8 9} increased morbidity and worse quality of life among older adults¹⁰ and in individuals with cardiovascular disease.¹¹ However, little research has examined the role of social connectivity in the context of post-ICU recovery.

With the increasing recognition of post-intensive care syndrome (PICS) and post-intensive care syndrome-family (PICS-F), there has been growing interest in post-ICU recovery programmes and the development of psychosocial supports for patients and their loved ones. PICS and PICS-F can affect the cognitive, psychological and physical domains of patients’ and families’ lives,¹² and may significantly influence social reintegration following critical illness. PICS is common among ICU survivors, with studies suggesting that approximately 30%–50% of patients experience new or worsening physical, cognitive or psychological impairments after critical illness.^{13 14} PICS-F is similarly prevalent, with reports suggesting that up to 70% of family members of ICU survivors experience anxiety.¹³ Despite this growing recognition, the role of social connectivity in the development and recovery from PICS and PICS-F remains poorly understood, particularly given its potential relevance to rehabilitation and recovery interventions. Examples of such interventions include post-ICU follow-up clinics, structured peer-support programmes, caregiver education initiatives and community-based rehabilitation services.

The objectives of this scoping review are to describe how social connectivity has been measured among ICU survivors and their families, examine reported associations between social connectivity and patient-relevant outcomes and identify gaps to inform future research. By mapping the existing evidence on social connectivity in the post-ICU context, this review aims to provide a foundation to guide clinical practice and inform the development of future research and rehabilitation initiatives.

Methods and analysis

This scoping review will be conducted following the Joanna Briggs Institute (JBI) methodology for scoping reviews,¹⁵ which provides guidance on defining the research question, identifying relevant studies, study selection, data charting and synthesis. Reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.¹⁶

The review will follow the five stages recommended by JBI: (1) defining the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data and (5) collating, summarising and reporting the results.

Specific objectives of this scoping review include:

1. Describe how social connectivity has been measured among ICU survivors and families.

2. Map reported associations between social connectivity and patient-relevant outcomes.

3. Identify implications for clinical practice.

4. Identify gaps for future research.

Study registration

The scoping review commenced in November 2025 following registration on the Open Science Framework, with screening and data extraction planned between December 2025 and March 2026 and manuscript completion anticipated in mid-2026.

Literature search

A literature search was designed in collaboration with a medical librarian to capture relevant studies from Ovid MEDLINE, Ovid EMBASE, CINAHL and Ovid APA PsycINFO. MEDLINE, EMBASE, CINAHL and PsycINFO were searched from database inception to December 2025, with the search to be updated prior to final analysis. Further review of the grey literature will also be performed, including the first 200 results from Google Scholar. As relevance ranking declines beyond the first several hundred results, screening was limited to the first 200 results, consistent with common practice in evidence reviews.¹⁷ Bibliographies from included studies will also be reviewed.

To capture all relevant literature pertaining to ICU survivorship and social connectivity, relevant keywords and controlled vocabulary will be carefully selected. A combination of the following search themes will be used: (1) critical care, intensive care and post-intensive care; and (2) social isolation, social deprivation, social connection, social cohesion and social network (see online supplemental table 1).

Eligibility criteria

Eligibility criteria were developed using the Population–Concept–Context framework recommended for scoping reviews. The population includes adult ICU survivors and adult (≥18 years) family members or caregivers; the concept is social connectivity, including social support, social networks, loneliness or social isolation; and the context is post-ICU recovery. Accordingly, studies will be included if they examine any aspect of social connectivity (eg, social support, social networks, loneliness, social isolation or social integration) in relation to outcomes among ICU survivors or their family caregivers.

Selection of sources/screening (level 1)

All studies from the search will be reviewed for initial title and abstract screening in Covidence, a web-based reference manager. Duplicates will be removed as part of the functionality of Covidence. Studies will be assessed for inclusion based on eligibility criteria in a two-part method. Titles and abstracts will be reviewed first and sorted into categories of ‘include’, ‘exclude’ or ‘maybe’ by two independent reviewers. Any disagreements will be resolved through discussion or consultation with a third reviewer. All abstracts marked as ‘included’ by one or more reviewers will move to part two, during which full texts are reviewed independently by two reviewers. Full texts will be assigned ‘include’ and ‘exclude’ by each reviewer, and discrepancies will be discussed to achieve consensus between the two reviewers, or by a third party. Reasons for exclusion will be recorded during full-text screening and summarised in the PRISMA flow diagram.

Data charting/extraction (level 2)

Data extraction will occur once citations are fully reviewed by the research team. A predefined data extraction form (see table 1) will be used for data collection by two independent reviewers. Collected data will be reviewed by the research team, and any discrepancies will be discussed to reach a consensus.

Table 1. Summary of data to be extracted from eligible articles in the scoping review.

	Citation 1	Citation 2
First author
Publication year
Type of study
Primary outcome
Site
Location
Age
# eligible patients
# enrolled patients
Population
% female
ICU LOS
Reason for admission
COVID-19
Inclusion criteria
Exclusion criteria
Intervention
Control
Comparison
Type of social support
Social support quantity
Type of outcome
Frequency of outcome measure
Physical function metric
Physical function outcome
Cognitive function metric
Cognitive function outcome
Pain metric
Pain outcome
Mental health metric
Mental health outcome
Satisfaction with life (HRQoL) metric
Satisfaction with life (HRQoL) outcome
Impact on family/caregivers
Impact on family/caregivers free text
General conclusions
Notes

HRQoL, health-related quality of life; ICU, intensive care unit; LOS, length of stay.

Synthesis

The conduct and reporting of this scoping review will follow the JBI methodology for scoping reviews¹⁵ and will be reported in accordance with the PRISMA-ScR.¹⁶

Extracted data will be summarised descriptively to map the characteristics of the included studies. Studies will be categorised according to how social connectivity is defined or operationalised, including measures of social support, social networks, loneliness or social isolation. Findings will be synthesised narratively, focusing on how social connectivity has been measured and how it has been examined in relation to patient-relevant outcomes among ICU survivors and their families. Outcomes of interest include physical function, cognitive function, pain, mental health and health-related quality of life. The synthesis will also identify patterns in the types of social connectivity described in the literature, such as family presence, peer support groups or structured post-ICU follow-up programmes. Finally, the review will highlight gaps in the existing literature to inform future research on the role of social connectivity in post-ICU recovery.

Patient and public involvement

Karsten Koch, a patient partner and survivor of critical illness, contributed to the co-design of this review and will also be involved in the development of a planned prospective study examining social connectivity and recovery after critical illness.

Discussion

Advances in critical care have substantially improved survival following severe illness; however, increasing attention is now directed towards the long-term morbidity experienced by survivors and their families. These sequelae, collectively described as PICS, include persistent impairments in physical, cognitive, psychological and social domains. As recognition of PICS has grown, there is increasing awareness of the complex and ongoing needs of ICU survivors and their caregivers during the recovery period.

Optimising recovery after critical illness has therefore emerged as a priority in critical care research and practice. Several supportive strategies have been proposed, including post-ICU recovery clinics, peer support programmes and community-based resources. Social connectivity—encompassing the quality and quantity of social relationships—may represent an important factor influencing recovery experiences and engagement with these supports.

Evidence from other populations suggests that social connectivity is associated with improved health outcomes, including reduced mortality among older adults and better outcomes in chronic cardiovascular disease. However, its role in post-ICU recovery has not been systematically characterised. ICU survivors and their caregivers may also experience distinct recovery challenges, and cultural or contextual factors may influence how social support is accessed and experienced.

This scoping review will map the existing literature on social connectivity in post-ICU populations, describe how it has been measured, and identify gaps in current knowledge. The findings will inform future research priorities and support the development of patient- and family-centred approaches to improving recovery after critical illness.

Ethics and dissemination

This study is a narrative review of published literature and does not involve human participants, personal health information or primary data collection; therefore, Research Ethics Board approval was not required in accordance with University of Alberta guidelines. For questions regarding research ethics or integrity, contact the University of Alberta Research Integrity Support office at researchintegrity@ualberta.ca. The findings will be disseminated through publication in a peer-reviewed journal.