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Characteristics of chronic obstructive pulmonary disease (COPD) can include shortness of breath, chronic cough, sputum production and reduced exercise capacity. The sit-to-stand (STS) test variations (e.g., 5-repetition STS, 30-second STS) may be appropriate outcome measures to assess exercise capacity in people with COPD. To date, the measurement properties of the various STS tests in people with COPD have not been synthesized in a systematic review since the publication of the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. The purpose of this proposed systematic review is to synthesize the literature of the measurement properties of the STS test variations among people with COPD. The review will be conducted with methods consistent with the COSMIN guidelines. Peer-reviewed publications will be included if they assessed the measurement properties (reliability, validity, responsiveness) of a STS test in community-dwelling adults with COPD. We will search six databases from inception. Study selection and data extraction will be conducted independently and in duplicate. We will assess the risk of bias using the COSMIN Risk of Bias tool, assess results against the COSMIN updated criteria for good measurement properties, and summarize certainty of evidence using the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Study results will be pooled by calculating weighted means and 95% confidence intervals or summarized narratively, as appropriate. This will be the first systematic review to synthesize the measurement properties of the STS tests in people with COPD using the methods recommended by COSMIN. Consequently, its results will be robust and may help clinicians or researchers identify the best variation of the STS test to use in their practice.

Inspiratory muscle training (IMT) is one possible strategy to ameliorate respiratory muscle weakness due to invasive mechanical ventilation. Recent systematic reviews have focused on respiratory outcomes with minimal attention to physical function. The newest systematic review searched the literature until September 2017 and a recent preliminary search identified 5 new randomized controlled trials focusing on IMT in critical care. As such, a new systematic review is warranted to summarize the current body of evidence and to investigate the effect of IMT on physical function in critical care. We will search for three main concepts (\"critical illness\", \"inspiratory muscle training\", \"RCT\") across six databases from their inception (MEDLINE, EMBASE, Emcare, AMED, CINAHL, CENTRAL) and ClinicalTrials.gov. Two reviewers will independently screen titles, abstracts, and full texts for eligibility using the Covidence web-based software. Eligible studies must include: (1) adult (≥18 years) patients admitted to the intensive care unit (ICU) who required invasive mechanical ventilation for ≥24 hours, (2) an IMT intervention using a threshold device with the goal of improving inspiratory muscle strength, with or without usual care, and (3) randomized controlled trial design. The primary outcome of interest will be physical function. We will use the Cochrane Risk of Bias Tools (ROB2) and will assess the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool. This protocol has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA- P) guidelines and is registered with the International Prospective Register of Systematic Reviews (PROSPERO). Results will summarize the body of evidence of the effect of IMT on physical function in critically ill patients. We will submit our findings to a peer-reviewed journal and share our results at conferences.

COVID-19 infection can lead to multi-organ dysfunction, which has been shown to contribute to the physical disability seen in people after hospital discharge. We aimed to understand the effects of hospitalization for COVID-19 on mobility, cognition, and daily activities over 24-months of follow up. This was a 24-month extension of the COREG-FR prospective cohort study (NCT04602260). We enrolled consecutive adult patients (≥18 years) with lab confirmed SARS-Cov-2 infection who were admitted to five Ontario, Canada hospitals between August 21, 2020, and December 21, 2021. Patients were excluded if they resided in an institution (e.g., long term care facility), had severe premorbid physical function limitations (e.g., unable to stand independently) or had cognitive impairment which limited their ability to complete follow-up assessment. We assessed mobility and cognitive status using the Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility Domain and Cognitive Domain, respectively. Deficits from premorbid status were determined using the minimal clinically important differences in mobility (≥ 3.3) and cognition (≥ 5.5). We also asked participants how much their COVID-19 recovery affected their daily activities within the preceding week with response options from 'not at all' to 'all the time'. Among the 215 participants who participated 12-months after hospital discharge, 170 (79%) consented to the 24-month follow-up. The mean (standard deviation) age was 61.2 (12.7) years and 54% (n = 91) of participants who were male. Compared to pre-morbid function, mobility and cognitive deficits were present in 57% and 41% of participants, respectively. Furthermore, 59% of participants reported COVID-19 continued to impact their daily activities. At 24-months after hospitalization for COVID-19, many participants experience persistent mobility and cognitive deficits. Future work should aim to develop comprehensive rehabilitation strategies for those recovering from COVID-19 which target mobility and cognitive function.

Many survivors of critical illness experience lasting physical disability. Post-hospital rehabilitation has the potential to reduce this physical disability; however, primary studies have reported inconsistent results. We aimed to answer the following question: Among community-dwelling adults who survived critical illness, does participation in post-hospital physical rehabilitation, compared with no rehabilitation or alternative non-physical interventions, improve physical functioning 12 months after discharge from acute care? This is a systematic review protocol that was registered with PROSPERO (CRD 420251174065). It will be conducted with Cochrane methods and reported according to the 2020 Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. To optimize the impact of this review, our study team includes a patient partner to guide our methods and interpretation. To be eligible, peer-reviewed randomized controlled trials must have enrolled community-dwelling adults (≥ 18 years) previously admitted to the ICU (≥24 hours) to a post-hospital physical rehabilitation program compared to any control. Outcomes of interest include physical function, return to work, and health care utilization. We will search five databases from their inception. Study screening, selection and extraction will be conducted independently and in duplicate using Covidence. Disagreements will be resolved through discussion or with a third reviewer. We will assess risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). Where appropriate, we will conduct meta-analyses using random-effects modeling. Certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). A recent international multiprofessional expert panel highlighted the importance of understanding how follow-up care models can optimize long-term recovery after critical illness. Our review will provide a comprehensive synthesis of the impact of post-hospital rehabilitation on long-term recovery of survivors of critical illness.

Chronic obstructive pulmonary disease (COPD) is a common, preventable lung disease which affects more than 300 million people worldwide. People with COPD have elevated levels of inflammatory biomarkers, which are linked to physiological alterations in the respiratory system and extrapulmonary manifestations. Pulmonary rehabilitation (PR) is one of the strategies used in the management of individuals with COPD irrespective of severity, however its effect on systemic inflammation is poorly understood. We report the protocol of a systematic review on the effects of PR on systemic inflammation in patients with COPD. Using the search terms \"chronic obstructive pulmonary disease\", \"pulmonary rehabilitation\", and \"inflammatory biomarkers\" and their synonyms, five databases (AMED, CINAHL, Ovid MEDLINE, MEDLINE (Pubmed), EMBASE) will be searched from their inception to identify primary literature evaluating the effects of PR on systemic inflammation. Two reviewers will independently screen titles, abstracts, and full texts for eligibility using the Covidence web-based software. Eligible studies must be published in a peer-reviewed journal and include: (1) participants with COPD undergoing PR with an exercise component of at least 4 weeks in length and (2) a measure of systemic inflammation (e.g., bloodwork or sputum sample) as an outcome of interest. We will use the Cochrane Risk of Bias Tools (ROB2 and ROBINS-I) and will rate the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool. This protocol has followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines and is registered with the International Prospective Register of Systematic Reviews (PROSPERO). The results of this systematic review will summarize the status of the evidence highlighting the effect of PR on systemic inflammation. A manuscript will be drafted and submitted to a peer-reviewed journal and shared at conferences.

Background With ICU mortality rates decreasing, it is increasingly important to identify interventions to minimize functional impairments and improve outcomes for survivors. Simultaneously, we must identify robust patient-centered functional outcomes for our trials. Our objective was to investigate the clinimetric properties of a progression of three outcome measures, from strength to function. Methods Adults (≥ 18 years) enrolled in five international ICU rehabilitation studies. Participants required ICU admission were mechanically ventilated and previously independent. Outcomes included two components of the Physical Function in ICU Test-scored (PFIT-s): knee extensor strength and assistance required to move from sit to stand (STS); the 30-s STS (30 s STS) test was the third outcome. We analyzed survivors at ICU and hospital discharge. We report participant demographics, baseline characteristics, and outcome data using descriptive statistics. Floor effects represented ≥ 15% of participants with minimum score and ceiling effects ≥ 15% with maximum score. We calculated the overall group difference score (hospital discharge score minus ICU discharge) for participants with paired assessments. Results Of 451 participants, most were male ( n  = 278, 61.6%) with a median age between 60 and 66 years, a mean APACHE II score between 19 and 24, a median duration of mechanical ventilation between 4 and 8 days, ICU length of stay (LOS) between 7 and 11 days, and hospital LOS between 22 and 31 days. For knee extension, we observed a ceiling effect in 48.5% (160/330) of participants at ICU discharge and in 74.7% (115/154) at hospital discharge; the median [1st, 3rd quartile] PFIT-s difference score ( n  = 139) was 0 [0,1] ( p  < 0.05). For STS assistance, we observed a ceiling effect in 45.9% (150/327) at ICU discharge and in 77.5% (79/102) at hospital discharge; the median PFIT-s difference score ( n  = 87) was 1 [0, 2] ( p  < 0.05). For 30 s STS, we observed a floor effect in 15.0% (12/80) at ICU discharge but did not observe a floor or ceiling effect at hospital discharge. The median 30 s STS difference score ( n  = 54) was 3 [1, 6] ( p  < 0.05). Conclusion Among three progressive outcome measures evaluated in this study, the 30 s STS test appears to have the most favorable clinimetric properties to assess function at ICU and hospital discharge in moderate to severely ill participants.

ObjectivesTo explore the use, parameters, safety and outcomes of physical rehabilitation for adults with sepsis.DesignWe conducted a scoping review following the Joanna Briggs Institute framework.ParticipantsStudies were eligible for inclusion in the study if they included: (1) adults 18 and older, (2) with a previous diagnosis of sepsis, (3) using a physical rehabilitation intervention at any point of sepsis management, (4) published in English or French.ProcedureWe searched seven databases and screened titles and abstracts, reviewed full texts and performed data extraction independently and in duplicate. We summarised findings narratively using the “population, context, concept” framework and used descriptive statistics where appropriate. End-users reviewed and commented on study findings.ResultsWe included 58 studies, representing 77 434 participants, with the majority (79%) being published in the last decade. A large proportion (36%) of physical rehabilitation interventions included exercise and were overseen by a physical therapist (41%). The parameters of the interventions varied widely. However, all interventions (100%) were hospital based and the interventions implemented appeared safe. Of the 28 studies evaluating effectiveness of the intervention, function improved in most studies (78%) following physical rehabilitation.ConclusionResearch addressing physical rehabilitation for patients with sepsis is increasing. Physical rehabilitation appears safe and may improve functional outcomes in those with sepsis. Future research should report details of intervention parameters and evaluate rehabilitation post-hospital discharge to maximise impact on function and quality of life for sepsis survivors.RegistrationThe protocol was registered on Open Science Framework Registries (Registration DOI: https://doi.org/10.17605/OSF.IO/2EPJ6).

Background Physical rehabilitation (PR) interventions can improve physical function for adults with frailty; however, participant retention rates in randomized controlled trials (RCTs) are unknown. Objective is to summarize participant retention rates in RCTs of PR for adults with frailty. Design is a systematic review and meta-analysis (DOI:10.17605/OSF.IO/G6XR2). Participants are adults ≥  18 years with frailty. Setting consists of inpatient, outpatient and community-based interventions. Intervention includes any PR intervention. Methods We searched 7 electronic databases from inception to April 15, 2020 for published RCTs. Our primary outcome was participant retention rate to primary outcome measurement. Secondary outcomes included retention by study group, participant retention to intervention completion, reported reasons for attrition and reported strategies for maximizing retention. We completed screening, data extraction and risk of bias (ROB) assessments independently and in duplicate. We conducted a meta-analysis, calculating retention rates and 95% confidence intervals (CIs) using fixed or random-effects models, as appropriate. Results We included 21 RCTs, enrolling 1685 adults with frailty (median age 82.5 years (79.0, 82.2), 59.8% female (57.5, 69.8)). Twenty RCTs reported retention data, of which 90.0% ( n = 18) had high ROB. The pooled participant retention rate to primary outcome measurement was 85.0% [95%CI (80.0, 90.0), I 2 = 83.9%, p < 0.05]. There were no differences by group for retention to the primary outcome [intervention 87.0% (83.0, 91.0), p < 0.05, comparator 85.0% (79.0, 90.0), p < 0.05] or in retention to intervention completion [83.0% (95.0% CI (78.0–87.0), p < 0.05]. Of the 18 studies reporting 24 reasons for attrition, 51.3% were categorized as potentially modifiable by the research team (e.g. low motivation). Only 20.0% ( n = 4) of studies reported strategies for maximizing retention. Conclusions In this review of 21 RCTs of PR, we identified acceptable rates of retention for adults with frailty. High retention in PR interventions appears to be feasible in this population; however, our results are limited by a high ROB and heterogeneity.

Background Clinical trials management can be studied using project management theory. The CYCLE pilot randomized controlled trial (RCT) was conducted to determine the feasibility of a future rehabilitation trial of early in-bed cycling in the intensive care unit (ICU). In-bed cycling is a novel intervention, not typically available in ICUs. Implementation of this intervention requires personnel with specialized clinical expertise caring for critically ill patients and use of the in-bed cycle. Our objective was to describe the implementation and conduct of our pilot RCT using a project management approach. Methods We retrospectively reviewed activities, timelines, and personnel involved in the trial. We organized activities into four project management phases: initiation, planning, execution, and monitoring and controlling. Data sources included Methods Centre documents used for trial coordination and conduct, and the trial data set. We report descriptive statistics as counts and proportions and also medians and quartiles, and we summarize the lessons learned. Results Seven ICUs in Canada participated in the trial. Time from research ethics board and contracts submission to first enrolment was a median (first quartile, third quartile) of 185 (146, 209) and 162 (114, 181) days, respectively. We trained 128 personnel on the CYCLE pilot RCT protocol, and 80 (63%) completed trial-related activities. Four sites required additional training after start-up due to staff turnover and leaves of absence. Over 15 months, we screened 864 patients: 256 were eligible and 66 were enrolled. Despite an 85% consent rate, 74% (190/256) of eligible patients were not randomized, largely (80% [152/190]) due to physiotherapist availability. Thirteen percent of recruitment weeks were lost due to physiotherapist staffing shortages. We highlight five key lessons learned: (1) prepare and anticipate site needs; (2) communicate regularly; (3) proactively analyse and act on process measure data; (4) develop contingency plans; (5) express appreciation to participating sites. Conclusions Our analysis highlights the scope of relevant activities, rigorous training and monitoring, number and types of required personnel, and time required to conduct a multicentre ICU rehabilitation intervention trial. Our lessons learned can help others interested in implementing complex intervention trials, such as rehabilitation. Trial registration ClinicalTrials.gov, NCT02377830 . Registered prospectively on 4 March 2015.

Following publication of the original article [1], we have been notified that one of the authors' names is spelled incorrectly. In this Correction the incorrect and correct author name are shown.Following publication of the original article [1], we have been notified that one of the authors' names is spelled incorrectly. In this Correction the incorrect and correct author name are shown.