Family presence and engagement during physiotherapy in pediatric intensive care units: a systematic review and critical evidence gap analysis.

The objective of this study is to assess whether family presence or engagement during PICU rehabilitation is associated with improved child mobility or function, and to identify evidence for structured family-delivered physiotherapy. PRISMA 2020-compliant systematic review of six databases (2000-March 2026) is guided by an unregistered internal protocol. Tier 1 included PICU rehabilitation interventions with an explicit family component; Tier 2 included observational studies of family presence/participation and mobility outcomes. The primary outcome of the study is child motor and functional recovery. Risk of bias was assessed with design-specific tools, certainty with GRADE. Seven primary studies were included. Across four point-prevalence cohorts (2737 patient-days), family presence/participation was associated with out-of-bed mobility (aOR 3.31-7.83), without causal inference. In a nested US safety cohort (4658 events), serious adverse events were rare (device dislodgement 0.3%). A pediatric liberation bundle with structured family engagement increased mobilisation and reduced benzodiazepine exposure. No primary study evaluated structured family-delivered physiotherapy with validated motor endpoints. An RCT of early protocolised rehabilitation showed earlier PT/OT/SLP involvement but no 6-month functional differences. Conclusion Family presence during PICU mobilisation is feasible and associated with increased mobility, but no primary study has tested structured family-delivered physiotherapy with validated motor outcomes. A pragmatic hybrid Type 1 effectiveness-implementation trial is needed.