Explore the vast range of titles available.

IntroductionEvidence shows that resistance training (RT) reduces lymphoedema in patients with breast cancer–related lymphoedema (BRCL), making it a safe and efficient intervention. However, it is uncertain if RT is safe and effective in patients at risk of developing BRCL. This systematic review (SR) protocol aims to describe all methodological aspects in order to evaluate the short-, medium- and long-term effects of RT on the prevention of BCRL.Materials and methodsThroughout 2024, randomised clinical trials (RCTs) will be identified in electronic databases MEDLINE/PubMed, Embase, Cochrane Central Register of Controlled Trials, PEDro and LILACS. Only studies in English, Spanish and Portuguese will be included. Grey literature and clinical trial registration will also be reviewed. The primary outcome will be the occurrence of lymphoedema and quality of life. Second, pain intensity, upper limb function, range of movement, grip strength and adverse events will be considered. The individual studies’ risk of bias will be evaluated using the Cochrane Risk of Bias 2.0 tool. Pairwise meta-analyses using a frequentist approach and random effects model will be conducted. The Grading of Recommendations Assessment, Development and Evaluation system will be used to evaluate the certainty of the evidence.Ethics and disseminationThis protocol does not require the approval of an ethics committee, as it is a secondary study. The results will be disseminated through peer-reviewed publications.PROSPERO registration numberCRD42023455720.

IntroductionBreast cancer-related lymphoedema (BCRL) is one of the most underestimated and debilitating complications associated with the treatment that women with breast cancer receive. Several systematic reviews (SRs) of different physical exercise programmes have been published, presenting disperse and contradictory clinical results. Therefore, there is a need for access to the best available and summarised evidence to capture and evaluate all the physical exercise programmes that focus on reducing BCRL.ObjectiveTo evaluate the effectiveness of different physical exercise programmes in reducing the volume of lymphoedema, pain intensity and improving quality of life.Method and analysisThe protocol of this overview is reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols, and its methodology is based on Cochrane Handbook for Systematic Reviews of Interventions. Only those SRs involving physical exercise by patients with BCRL will be included, whether on its own or combined with other exercises or other physical therapy interventions.The outcomes of interest to be considered will be lymphoedema volume, quality of life, pain intensity, grip strength, range of motion, upper limb function and any adverse event. The MEDLINE/PubMed, Lilacs, Cochrane Library, PEDro and Embase databases will be searched for reports published from database inception to April 2023.Two researchers will perform study selection, data extraction and risk of bias assessment independently. Any discrepancy will be resolved by consensus, or ultimately, by a third-party reviewer. We will use Grading of Recommendations Assessment, Development and Evaluation System to assess the overall quality of the body of evidence.Ethics and disseminationThe results of this overview will be published in peer-reviewed scholarly journals and the scientific dissemination will take place in national or international conferences. This study does not require approval from an ethics committee, as it does not directly collect information from patients.PROSPERO registration numberCRD42022334433.

IntroductionLymphoedema associated with breast cancer is caused by an interruption of the lymphatic system, together with factors such as total mastectomy, axillary dissection, positive lymph nodes, radiotherapy, use of taxanes and obesity. Physiotherapy treatment consists of complex decongestive therapy, manual lymphatic drainage and exercises, among other interventions. Currently, there are several systematic review and randomised controlled trials that evaluate the efficacy of these interventions. However, at present, there are no studies that compare the effectiveness of all these physical therapy interventions. The purpose of this study is to determine which physical therapy treatment is most effective in reducing breast cancer-related lymphoedema, improving quality of life and reducing pain.Methods and analysisMEDLINE, PEDro, CINAHL, EMBASE, LILACS and Cochrane Central Register of Controlled Trials will be searched for reports of randomised controlled trials published from database inception to June 2022. We will only include studies that are written in English, Spanish and Portuguese. We will also search grey literature, preprint servers and clinical trial registries. The primary outcomes are reduction of secondary lymphoedema associated with breast cancer, improvements in quality of life and pain reduction. The risk of bias of individual studies will be evaluated using the Cochrane Risk of Bias 2.0 Tool. A network meta-analysis will be performed using a random-effects model. First, pairs will be directly meta-analysed and indirect comparisons will be made between the different physical therapy treatments. The GRADE system will be used to assess the overall quality of the body of evidence associated with the main results.Ethics and disseminationThis protocol does not require approval from an ethics committee. The results will be disseminated via peer-reviewed publications.PROSPERO registration numberCDR42022323541.

Rationale Intensive care unit-acquired weakness (ICUAW) is common in critically ill patients, characterized by muscle weakness and physical function loss. Determining risk factors for ICUAW poses challenges due to variations in assessment methods and limited generalizability of results from specific populations, the existing literature on these risk factors lacks a clear and comprehensive synthesis. Objective This overview aimed to synthesize risk factors for ICUAW, categorizing its modifiable and nonmodifiable factors. Methods An overview of systematic reviews was conducted. Six relevant databases were searched for systematic reviews. Two pairs of reviewers selected reviews following predefined criteria, where bias was evaluated. Results were qualitatively summarized and an overlap analysis was performed for meta-analyses. Results Eighteen systematic reviews were included, comprising 24 risk factors for ICUAW. Meta-analyses were performed for 15 factors, while remaining reviews provided qualitative syntheses. Twelve reviews had low risk of bias, 4 reviews were unclear, and 2 reviews exhibited high risk of bias. The extent of overlap ranged from 0 to 23% for the corrected covered area index. Nonmodifiable factors, including advanced age, female gender, and multiple organ failure, were consistently associated with ICUAW. Modifiable factors, including neuromuscular blocking agents, hyperglycemia, and corticosteroids, yielded conflicting results. Aminoglycosides, renal replacement therapy, and norepinephrine were associated with ICUAW but with high heterogeneity. Conclusions Multiple risk factors associated with ICUAW were identified, warranting consideration in prevention and treatment strategies. Some risk factors have produced conflicting results, and several remain underexplored, emphasizing the ongoing need for personalized studies encompassing all potential contributors to ICUAW development.

The high-flow nasal cannula (HFNC) has become a widely used respiratory support system, which has proven to be effective in different populations. The facilitation of oral communication and feeding have been described as advantages of this support. Nevertheless, swallowing disorders associated with the use of HFNC have been postulated. However, such evidence is scattered in the literature, not systematically searched, and needs to be adequately summarised. This review aimed to explore the literature, to identify and map the evidence, regarding the frequency and methods of assessment of swallowing disorders in adult HFNC users, in both critical and non-critical units. A scoping review will be conducted. A systematic search in MEDLINE (Ovid), Embase (Ovid), CENTRAL, CINAHL (EBSCOhost), and other resources will be conducted. Primary studies, in any language or publication status, assessing the incidence of swallowing disorders in adults with HFNC support will be included. Two reviewers will independently select studies and extract data. Disagreements will be resolved by consensus or a third reviewer. The results will be reported narratively, using tables and figures to support them. Positive end-expiratory pressure generated in the airway by HFNC could impair the proper swallowing performance. Knowing the methodological characteristics, the instruments or scales used to assess the presence of dysphagia, and the results of the studies may contribute to considering swallowing assessment in this population on a routine basis, as well as to guide the conduct of new studies that may respond to less researched areas in this topic. Registration number: INPLASY2022110078.

Exercise interventions have a positive impact on people with stroke. However, access to exercise interventions is variable, and there may be a delay in the start of rehabilitation. Telerehabilitation has enabled the delivery of exercise interventions replacing the traditional face-to-face approach. Aspects related to the safety of people with stroke should be considered to avoid adverse events during the delivery of exercise interventions remotely. However, such information is scattered in the literature, and the detail with which measures taken during the implementation of exercise interventions for people with stroke are reported is unknown. To summarise measures or aspects targeted at reducing the incidence of adverse events during the delivery of exercise interventions through telerehabilitation in patients after stroke. A scoping review will be conducted. A systematic search in MEDLINE-Ovid, Embase-Ovid CENTRAL, CINAHL Complete (EBSCOhost), and other resources will be carried out. We will include primary studies, published in full text in any language, involving people with stroke who undergo telerehabilitation where exercise is the main component. Two reviewers will independently select studies and extract data, and disagreements will be resolved by consensus or a third reviewer. The results will be reported in a narrative form, using tables and figures to support them. To implement this strategy within rehabilitation services, one of the first aspects to be solved is to ensure the safety of people. The results of this scoping review could contribute an information base for clinicians and decision-makers when designing remotely delivered exercise intervention programs. INPLASY202290104.

Adult and pediatric patients admitted to intensive care units (ICUs) requiring invasive ventilatory support, sedation, and muscle blockade may present neuromusculoskeletal deterioration. Different physical rehabilitation interventions have been studied to evaluate their effectiveness in improving critically ill patients' outcomes. Given that many published systematic reviews (SRs) aims to determine the effectiveness of different types of physical rehabilitation interventions, it is necessary to group them systematically and assess the methodological quality of SRs to help clinicians make better evidence-based decisions. This overview of SRs (OoSRs) aims to map the existing evidence and to determine the effectiveness of physical rehabilitation interventions to improve neuromusculoskeletal function and other clinical outcomes in adult and pediatric critically ill patients. An OoSRs of randomized and non-randomized clinical trials involving critically ill adult and pediatric patients receiving physical rehabilitation intervention will be conducted. A sensitive search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos, and other search resources will be conducted. Two independent reviewers will conduct study selection, data extraction, and methodological quality assessment. Discrepancies will be resolved by consensus or a third reviewer. The degree of overlap of studies will be calculated using the corrected covered area. The methodological quality of the SRs will be measured using the AMSTAR-2 tool. The GRADE framework will report the certainty of evidence by selecting the \"best\" SR for each physical rehabilitation intervention and outcome. The findings of this overview are expected to determine the effectiveness and safety of physical rehabilitation interventions to improve neuromusculoskeletal function in adult and pediatric critically ill patients based on a wide selection of the best available evidence and to determine the knowledge gaps in this topic by mapping and assessing the methodological quality of published SRs. CRD42023389672.

Background/Objectives: Myokines can modulate organ function and metabolism, offering a protective profile against ICU complications beyond preventing local muscle wasting. This scoping review aims to explore and summarize the evidence regarding the secretion of myokines and their potential local or systemic effects in critically ill patients. Methods: A scoping review following Joana Briggs Institute recommendations was conducted. A systematic search of MEDLINE (Ovid), Embase (Ovid), CENTRAL, CINAHL (EBSCOhost), WoS, and Scopus was conducted from inception to February 2023. We included primary studies evaluating myokine secretion/concentration in critically ill adults undergoing physical rehabilitation interventions. Two independent reviewers performed study selection and data extraction. Results: Seventeen studies published between 2012 and 2023 were included. Most were randomized clinical trials (47%). Physical rehabilitation interventions included electrical muscle stimulation, as well as passive and active mobilization, delivered alone or combined, in single or daily sessions lasting 20–60 min. Twelve studies (70%) evaluated interleukin-6, while interleukin-10, tumour necrosis factor-α, Interleukin-8, and myostatin were also commonly studied. Thirteen studies (76%) reported changes in myokine secretion or gene expression, although no clear concentration change pattern emerged. Myokines involved in muscle protein synthesis and breakdown may protect against muscle waste and weakness. Conclusions: The study of myokine dynamics in critically ill patients highlights the systemic impact of physical rehabilitation. This emerging field has grown in interest over the past decade, offering significant research potential. However, challenges such as study design, small sample sizes, and variability in physical therapy protocols hinder a comprehensive understanding of myokine responses.

Background: Breast cancer-related lymphedema (BCRL) is a common complication that impairs function and quality of life (QoL). The comparative effectiveness of physical therapy interventions (PTIs) remains unclear. This systematic review and network meta-analysis (NMA) was conducted to identify the most effective PTIs for BCRL management. Methods: A systematic search of Medline/PubMed, LILACS, CENTRAL, PEDro, and CINAHL was conducted up to July 2024. Eligible studies were randomized controlled trials (RCTs) involving women with BCRL, evaluating PTIs delivered alone or in combination. Primary outcomes were lymphedema volume, volume reduction, percentage reduction, QoL, and pain. Secondary outcomes included range of motion (ROM), grip strength, and adverse events. A frequentist NMA was performed, and certainty of evidence (CoE) was assessed using the GRADE approach. Results: Eighty-three RCTs were identified, of which twenty-six (1203 participants) were included in the NMA, assessing 23 PTIs. Based on moderate CoE, yoga was among the most effective interventions for improving QoL within 6 months compared to usual standard care (USC). The multimodal approach, with or without a home exercise program, showed intermediate benefits for external rotation and may also improve shoulder abduction (low to moderate CoE). No intervention demonstrated clear superiority over USC for other outcomes. Adverse events were reported with kinesiotaping and compression measures. Conclusions: The evidence supports yoga and multimodal programs as potential short-term strategies for improving QoL and shoulder mobility in women with BCRL. However, the predominance of low-to-very-low CoE underscores the need for individualized clinical decisions and future high-quality RCTs with standardized comparators, larger samples, and longer follow-up. The consistent use of standardized comparators will be crucial in improving network connectivity and enabling more robust and comprehensive comparisons across multiple interventions.

Introducción: Diferentes estudios chilenos han publicado ecuaciones de referencia para la distancia recorrida (DR6min) en la prueba de caminata de seis minutos (PC6min) en niños chilenos sanos; sin embargo, su precisión es baja. Objetivo: Desarrollar nuevas ecuaciones de referencia para determinar si un protocolo de estimulación constante permite predecir con mayor precisión la DR6min en la PC6min en población pediátrica chilena. Secundariamente, construir curvas de normalidad de la respuesta fisiológica frente a la PC6min. Metodología: Se realizó un análisis post-hoc de un estudio observacional que incluyó 294 niños entre seis a 14 años de la Región Metropolitana, Chile, los cuales fueron sometidos a un protocolo de estimulación constante. Se excluyeron niños con IMC anormal y con datos faltantes. Se realizó un análisis de regresión lineal múltiple para desarrollar ecuaciones de referencia, y se construyeron curvas de normalidad para el porcentaje de la frecuencia cardiaca de reserva (%FCR) utilizada. Resultados: Se incluyeron 200 (68%) niños, de los cuales 117 (59%) fueron mujeres. La DR6min puede ser predicha con la siguiente ecuación: 626,42 x talla (metros) + 10,75 x edad (años) – 6,03 x peso (kg) – 54,97 (R2 43,75%). Además, se presentaron curvas de normalidad para la %FCR utilizada mediante la determinación de los percentiles 5, 10, 25, 50, 75, 90, y 95. Conclusiones: La ecuación propuesta por este estudio predice la DR6min en la PC6min en niños chilenos sanos entre seis y 14 años con una mejor precisión en comparación a las ecuaciones publicadas hasta el momento. Futuros estudios deben incorporar una cohorte de validación para mejorar la validez de los resultados. Introduction: Various studies conducted in Chile have published reference equations for distance walked (6MWD) during the six-minute walk test (6MWT) in healthy Chilean children; however, their accuracy remains low. Objective: To develop new reference equations to determine if a constant stimulation protocol allows a more accurate prediction of 6MWD in the 6MWT in the Chilean pediatric population. Secondly, to construct normality curves of the physiological response to 6MWT. Methodology: We performed a post-hoc analysis of an observational study that included 294 children aged 6 to 14 from the Metropolitan Region, Chile, subjected to a constant stimulation protocol. Children with abnormal BMI and missing data were excluded. A multiple linear regression analysis was performed to develop reference equations, and normality curves were constructed for the percentage of the heart rate reserve (%HRR) used. Results: 200 (68%) children were included, and 117 (59%) were female. The 6MWD can be predicted with the following equation: 626.42 x height (meters) + 10.75 x age (years) - 6.03 x weight (kg) - 54.97 (R2 43.75%). In addition, normality curves were presented for the %HRR used by determining the 5th, 10th, 25th, 50th, 50th, 75th, 90th, and 95th percentiles. Conclusions: The equation proposed by this study predicts 6MWD in 6MWT in healthy Chilean children between six and 14 years of age with better accuracy compared to equations published so far. Future studies should incorporate a validation cohort to improve the validity of the results. Introdução: Vários estudos realizados no Chile publicaram equações de referência para a distância percorrida (DTC6) durante o teste de caminhada de seis minutos (TC6) em crianças chilenas saudáveis; no entanto, a sua precisão permanece baixa.Objectivo: Desenvolver novas equações de referência para determinar se um protocolo de estimulação constante permite uma previsão mais precisa da DTC6 no TC6 na população pediátrica chilena. Em segundo lugar, construir curvas de normalidade da resposta fisiológica ao TC6.Metodologia: Realizamos uma análise post-hoc de um estudo observacional que incluiu 294 crianças dos 6 aos 14 anos da Região Metropolitana do Chile, submetidas a um protocolo de estimulação constante. As crianças com IMC anormal e dados em falta foram excluídas. Foi realizada uma análise de regressão linear múltipla para desenvolver equações de referência, e foram construídas curvas de normalidade para a percentagem da frequência cardíaca de reserva (%FCR) utilizada. Resultados: Foram incluídas 200 (68%) crianças, sendo 117 (59%) do sexo feminino. A DTC6 pode ser prevista pela seguinte equação: 626,42 x altura (metros) + 10,75 x idade (anos) - 6,03 x peso (kg) - 54,97 (R2 43,75%). Além disso, foram apresentadas curvas de normalidade para a %FCR utilizada, determinando os percentis 5, 10, 25, 50, 50, 75, 90 e 95.Conclusões: A equação proposta neste estudo prevê a DTC6 no TC6 em crianças chilenas saudáveis ​​entre os seis e os 14 anos de idade com maior precisão em comparação com as equações publicadas até à data. Estudos futuros devem incorporar uma coorte de validação para melhorar a validade dos resultados.