Physical Rehabilitation Interventions in Pediatric Critical Care Research: A scoping review of methodology and reporting
CCCF ePoster library. Zorko D. 11/13/19; 283417; EP106
Dr. David Zorko
Dr. David Zorko
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Topic: Systematic Review, Meta-Analysis, or Meta-Synthesis

Zorko, David J1; Reid, Julie C2; Unger, Janelle3; McCaskell, Devin4; Saddik, Maisa5; Choong, Karen1,6,7; Kho, Michelle E2,4
1. Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; 2. School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; 3. Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; 4. Department of Physiotherapy, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; 5. Department of Surgery, McMaster University, Hamilton, Ontario, Canada; 6. Department of Pediatric Critical Care, McMaster University, Hamilton, Ontario, Canada; 7. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

Introduction: There is great research interest in physical rehabilitation (PR) interventions initiated in the pediatric intensive care unit (PICU) that may moderate PICU-acquired complications and optimize functional outcomes in critically ill children. PR is complex and usually includes multicomponent interventions that require tailoring to the individual patient within a heterogeneous critically ill population. The variability in reporting of PR interventions in studies of critically ill adults has been identified as a barrier to evaluating the efficacy of PR interventions [1-3]. The completeness of PR intervention reporting in pediatric studies has not been previously evaluated. Objectives: To conduct a scoping review and evaluate original prospective research of PR interventions in critically ill children. Our outcomes of interest were to describe the extent and nature of research in this field, the primary outcomes evaluated in included studies, quality of study reporting, and completeness of PR intervention reporting. Methods: We searched 5 electronic databases for prospective PR studies conducted in PICUs from inception to December 31, 2018. Title, abstract, and full-text screening was conducted independently in duplicate. We abstracted study characteristics, stated outcomes, and details of interventions studied. Quality of study reporting was assessed using standardized study reporting tools. Completeness of PR intervention reporting was assessed using the Consensus on Exercise Reporting Template (CERT). Reporting was calculated as a percentage of reporting tool items reported and classified as good (≥70%), moderate (50%-70%), or poor (≤50%). Results: We included 20 studies enrolling a total of 2,644 children. Median (Q1,Q3) sample size was 57 (44,104). Seven studies (35.0%) were randomized controlled trials. The types of PR interventions studied are summarized in Table 1. Eleven studies (55.0%) focused on chest physiotherapy (CPT); of these, the most common intervention was multicomponent CPT (72.7%). Nine studies (45.0%) evaluated physical activity interventions, most commonly progressive mobility (55.6%). The majority of stated outcomes (80.0%) were clinical outcomes limited to the PICU setting. Study and PR intervention reporting outcomes are summarized in Table 2. Overall, median (Q1,Q3) quality of study reporting was good (77.2% (66.7%,87.4%)), and completeness of PR intervention reporting was moderate (61.9% (45.9%,71.5%)). Conclusion: PR research in critically ill children is limited, and to date, focused on CPT and short-term clinical outcomes. While overall quality of study reporting amongst PR research in this review was good, completeness of PR intervention reporting was suboptimal. The use of CERT may improve design and reporting in future PR studies.

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1. Castro-Avila AC, Serón P, Fan E, et al. Effect of early rehabilitation during intensive care unit stay on functional status: Systematic review and meta-analysis. PloS one 2015;10(7):e0130722. doi: 10.1371/journal.pone.0130722
2. Connolly B, O'neill B, Salisbury L, et al. Physical rehabilitation interventions for adult patients during critical illness: An overview of systematic reviews. Thorax 2016;71(10):881-90. doi: 10.1136/thoraxjnl-2015-208273
3. Tipping CJ, Harrold M, Holland A, et al. The effects of active mobilisation and rehabilitation in ICU on mortality and function: A systematic review. Intensive Care Medicine 2017;43(2):171-83. doi: 10.1007/s00134-016-4612-0


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