116 CHAPTER 7 assure agreement and identify discrepancies. Extracted data included: (I) study characteristics (author, year, aim of the study, design, number of participants [n]), (II) relevant patient characteristics (age, body mass index [BMI], disease severity, ICU length of stay, ICU-admission category), (III) relevant outcome measures (QoL, physical functioning, muscle health, mortality, nutritional delivery when reported as a primary or secondary outcome ), (IV) measured as a post-intervention or change from baseline outcome, (V) intervention characteristics (protein target, enteral nutrition [EN] or parenteral nutrition [PN], type of exercise therapy in the intervention and comparator group), (VI) measures of central tendency (mean, median), statistical dispersion (standard deviation [SD], interquartile-range [IQR]), 95%-confidence interval (CI) and p-value if available. 7.2.6 Quality assessment Two reviewers independently assessed the risk of bias with the revised tool for Risk of Bias in Randomized Trials (RoB2)41 for RCTs and the Risk of Bias in Non-Randomized Studies of Intervention tool (ROBINS-I)42 for NRSI. The ROBINS-I formwas complementedwith a list of relevant confounding domains and co-interventions. Confounding domains included: (I) presence of comorbidities and high disease severity (i.e. sepsis, acute organ failure), (II) ICU-characteristics (i.e. admission type, length of stay, duration of mechanical ventilation), (III) demographic data (i.e. age, gender), (IV) physical status (i.e. physical functioning, frailty), (V) nutritional status (i.e. malnutrition, BMI), and (VI) nutritional management (i.e. energy delivery, use of PN). Co-interventions included: (I) n on-nutritional calories, (II) nutritional and/or physical interventions according to standard ICU-protocol, (III) NMES, (IV) immune nutrition, and (V) anabolic steroid use. Each judgment was made by responding to signalling questions of different domains that covered all types of bias, resulting in overall risk of bias judgment.
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