We thank Sundarsingh and colleagues [
1] for their insightful comments on the importance of physiotherapy for critically ill patients [
2]. Given the neuromuscular impact of critical illness and intensive care unit (ICU) care, physiotherapy is naturally considered beneficial. For example, early mobilisation during ICU stay has been shown to improve outcomes in the short term, by reducing delirium and ICU-acquired weakness, and in the long term, by reducing long-term cognitive impairment and improving quality of life (QoL) [
3]. However, such benefits have not been obtained with post-ICU follow-up based on physiotherapy. In their meta-analysis published in 2019, Rosa and colleagues concluded that post-ICU physiotherapy had some beneficial effect on depression and short-term mental QoL, but none on long-term overall QoL and physical ability [
4]. Its impact on long-term cognitive impairment had only been assessed in small studies. Since then, numerous trials are still pending. So why, paradoxically, is it so difficult to demonstrate the benefits of physical therapy-based Post-ICU follow-up? The complexity lies in the fact that we need to design physical therapy that is adapted to the patient's physical abilities and needs, but which is also accessible and acceptable to patients over the long term. Should post-ICU follow-up involve community physiotherapists or a hospital rehabilitation team? In France, both are overwhelmed by demand. We must consider the fact that many patients are reluctant to attend post-ICU follow-up after leaving hospital. In addition, the choice of outcome is difficult because there is no reason to rank physical, psychological and cognitive impairments in order of importance, but also because improving quality of life is not easily achievable. For example, we failed to show that personalised exercise training improved QoL in patients with myasthenia gravis (the paragon of muscle fatigability), despite its physical tolerability and benefits [
5]. …
