Measurement and reporting of physical rehabilitation interventions in pediatric critical care: a scoping review

Abstract

Purpose

To describe and evaluate physical rehabilitation research in critically ill children, including physical rehabilitation intervention reporting.

Methods

We searched five electronic databases to 31 December 2018 for prospective physical rehabilitation studies conducted in pediatric intensive care units (PICU). Screening was conducted independently in duplicate. Study characteristics, outcomes, and interventions were extracted from included studies. Quality of study reporting was assessed using standardized tools. Completeness of physical rehabilitation intervention reporting was assessed using the Consensus on Exercise Reporting Template (CERT).

Results

We included 20 studies enrolling a total of 2644 patients. Median (Q1,Q3) sample size was 57 (44,104). Seven studies (35%) were randomized controlled trials. Eleven studies (55%) evaluated respiratory interventions, most commonly multicomponent chest physiotherapy (73%). Nine studies (45%) evaluated physical activity interventions, most commonly progressive mobility (56%). The majority of stated outcomes (92.5%) were limited to the PICU setting. Median [Q1,Q3] quality of study reporting was good (77.2% [66.7%,87.4%]), and completeness of physical rehabilitation intervention reporting was moderate (61.9% [45.9%,71.5%]).

Conclusion

Physical rehabilitation studies in critically ill children were small, and focused on evaluating respiratory-based interventions and short-term PICU-based outcomes. Reporting of physical rehabilitation interventions was suboptimal. Use of CERT may improve design and reporting in future studies.

Implications for rehabilitation

• While physical rehabilitation research in critically ill children is a growing field, there are currently few studies evaluating physical rehabilitation interventions in this population.

• Physical rehabilitation studies to date have been small, focused on evaluating respiratory-based interventions and short-term outcomes limited to the PICU setting.

• The reporting of physical rehabilitation interventions in this population is suboptimal, making it challenging for clinicians to reproduce interventions and appraise their efficacy or safety.

Keywords:

• Critical care
• critical illness
• pediatrics
• physical medicine
• rehabilitation
• scoping review

Acknowledgements

The authors are grateful to the following people for their contributions to screening, data extraction and/or review of data for accuracy (in alphabetical order): Michael Ciancone, Aileen Costigan, Ravish Gupta, Magda McCaughan, Alex Molloy, and Heather O’Grady.

Author contributions

JCR, JU, and MEK designed the study; DJZ, JCR, JU, DM, and MS abstracted data and checked data for accuracy; DJZ, JCR, JU, KC and MEK conducted analyses; DJZ, JCR, JU, DM, MS, KC and MEK all contributed to interpret the data. All authors read the manuscript, provided feedback, and approved the manuscript for submission. DJZ and JCR contributed equally as first authors. KC and MEK contributed equally as senior authors.

Disclosure statement

The authors have no conflicts of interest to declare.

Additional information

Funding

MEK is funded by a Canada Research Chair. JCR was funded by a Canadian Respiratory Health Professionals Fellowship Award and an Ontario Graduate Scholarship. The funders had no role in study design, data extraction and analysis, decision to publish, or preparation of the manuscript.