Objetivo
Proporcionar un resumen oportuno, riguroso y continuamente actualizado de la evidencia disponible sobre el papel de la rehabilitación pulmonar en el tratamiento de los pacientes con COVID-19.

Diseño
Es el protocolo de una revisión sistemática viva.

Fuente de datos
Realizaremos búsquedas en la plataforma L·OVE (Living OVerview of Evidence) para COVID-19, un sistema que mapea los componentes de las preguntas de investigación (PICO) en un repositorio mantenido a través de búsquedas regulares en bases de datos electrónicas, servidores de pre-impresión, registros de ensayos y otros recursos relevantes para COVID-19. No se aplicarán restricciones de fecha ni de idioma.

Criterios de elegibilidad para la selección de estudios y métodos
Se adaptó un protocolo común ya publicado para revisiones sistemáticas paralelas múltiples a las especificidades de la pregunta. Se incluirán ensayos aleatorios que evalúen el efecto de la rehabilitación pulmonar como monoterapia o en combinación con otras intervenciones frente a un tratamiento simulado o ningún tratamiento en pacientes con COVID-19. Dos revisores examinarán de forma independiente cada estudio para determinar su elegibilidad, extraerán los datos y evaluarán el riesgo de sesgo. Se agruparán los resultados mediante un metaanálisis y se aplicará el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE) para evaluar la certeza de las pruebas para cada resultado.

Ética y difusión
No se considera necesaria la aprobación ética. Los resultados de esta revisión se difundirán ampliamente a través de publicaciones revisadas por pares, redes sociales y medios de comunicación tradicionales.

Authors: Stefanie Arce Pardo[1], Shuheng Lai[2], Luis Ortiz-Muñoz [3,4], Rocío Bravo-Jeria[5], Francisca Verdugo-Paiva[3,6], Gabriel Rada[3,6,7], COVID-19 L·OVE Working Group

Colaboradores:

Affiliation:
[1] Dr. Exequiel González Cortés Hospital, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
[2] Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
[3] UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile, Santiago, Chile
[4] Chilean satellite of The Cochrane Effective Practice and Organisation of Care (EPOC), Santiago, Chile
[5] Departamento de Evaluación de Tecnologías Sanitarias y Salud Basada en Evidencia, División de Planificación Sanitaria, Ministerio de Salud, Santiago, Chile
[6] Epistemonikos Foundation, Santiago, Chile
[7] Internal Medicine Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

E-mail: leortizmunoz@uc.cl

Author address:
[1] Diagonal Paraguay 476,
Santiago, Chile

Citation: Arce Pardo S, Lai S, Ortiz-Muñoz L, Bravo-Jeria R, Verdugo-Paiva F, Rada G. Pulmonary rehabilitation for COVID-19: A living systematic review protocol . Medwave 2021;21(6):e8223 doi: 10.5867/medwave.2021.06.8223

Submission date: 16/2/2021

Acceptance date: 11/5/2021

Publication date: 7/7/2021

Origin: Not commissioned

Type of review: Externally peer-reviewed by four reviewers, double-blind

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1. World Health Organization. Director-General's remarks at the media briefing on 2019-nCoV on 11 February 2020. World Health Organization; 2020. [On line] | Link |
2. Li LQ, Huang T, Wang YQ, Wang ZP, Liang Y, Huang TB, et al. COVID-19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020 Jun;92(6):577-583. | CrossRef | PubMed |
3. World Health Organization. [On line] | Link |
4. World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. [On line] | Link |
5. Hui DS, I Azhar E, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health - The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020 Feb;91:264-266. | CrossRef | PubMed |
6. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020 May;109:102433. | CrossRef | PubMed |
7. Fang Z, Yi F, Wu K, Lai K, Sun X, Zhong N, et al. Clinical characteristics of Coronavirus Disease 2019 (COVID-9): An updated systematic review. BMJ (2020). | CrossRef |
8. Nasiri M. COVID-19 clinical charaterisitics, and sex-specific rosk of mortality: systematic review and meta-analysis. BMJ (2020). | CrossRef |
9. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020 Mar-Apr;34:101623. | CrossRef | PubMed |
10. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Apr 30;382(18):1708-1720. | CrossRef | PubMed |
11. Bai C, Chotirmall SH, Rello J, Alba GA, Ginns LC, Krishnan JA, et al. Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020). Eur Respir Rev. 2020 Oct 5;29(157):200287. | CrossRef | PubMed |
12. Garrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect. 2020 Dec;81(6):e4-e6. | CrossRef | PubMed |
13. Weerahandi H, Hochman KA, Simon E, Blaum C, Chodosh J, Duan E, et al. Post-discharge health status and symptoms in patients with severe COVID-19. medRxiv [Preprint]. 2020 Aug 14:2020.08.11.20172742. | CrossRef | PubMed |
14. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013 Oct 15;188(8):e13-64. | CrossRef | PubMed |
15. Nikoletou D, Man WD, Mustfa N, Moore J, Rafferty G, Grant RL, et al. Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests. Disabil Rehabil. 2016;38(3):250-9. | CrossRef | PubMed |
16. Pinheiro G, Saldías F. Entrenamiento muscular inspiratorio en el paciente con enfermedad pulmonar obstructiva crónica. Rev Chil Enf Respir 2011; 27: 116-123. | CrossRef |
17. Hilton N, Solis-Moya A. Respiratory muscle training for cystic fibrosis. Cochrane Database Syst Rev. 2018 May 24;5(5):CD006112. | CrossRef | PubMed |
18. Lau HM, Ng GY, Jones AY, Lee EW, Siu EH, Hui DS. A randomised controlled trial of the effectiveness of an exercise training program in patients recovering from severe acute respiratory syndrome. Aust J Physiother. 2005;51(4):213-9. | CrossRef | PubMed |
19. COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. | Link |
20. Zhao HM, Xie YX, Wang C. Recommendations for respiratory rehabilitation in adults with coronavirus disease 2019. Chin Med J (Engl). 2020 Jul;133(13):1595-1602. | CrossRef | PubMed |
21. Wang TJ, Chau B, Lui M, Lam GT, Lin N, Humbert S. Physical Medicine and Rehabilitation and Pulmonary Rehabilitation for COVID-19. Am J Phys Med Rehabil. 2020 Sep;99(9):769-774. | CrossRef | PubMed |
22. Candan SA, Elibol N, Abdullahi A. Consideration of prevention and management of long-term consequences of post-acute respiratory distress syndrome in patients with COVID-19. Physiother Theory Pract. 2020 Jun;36(6):663-668. | CrossRef | PubMed |
23. Bissett B, Gosselink R, van Haren FMP. Respiratory Muscle Rehabilitation in Patients with Prolonged Mechanical Ventilation: A Targeted Approach. Crit Care. 2020 Mar 24;24(1):103. | CrossRef | PubMed |
24. Elkins M, Dentice R. Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review. J Physiother. 2015 Jul;61(3):125-34. | CrossRef | PubMed |
25. Qi D, Yan X, Xiang J, Peng J. Effects of early physical and pulmonary rehabilitation for severely and critically ill COVID-19 patients: a retrospective, cohort, and multicenter study. Research square 2020. | CrossRef |
26. Spruit MA, Holland AE, Singh SJ, Tonia T, Wilson KC, Troosters T. COVID-19: Interim Guidance on Rehabilitation in the Hospital and Post-Hospital Phase from a European Respiratory Society and American Thoracic Society-coordinated International Task Force. Eur Respir J. 2020 Aug 13;56(6):2002197. | CrossRef | PubMed |
27. Kalirathinam D, Guruchandran R, Subramani P. Comprehensive physiotherapy management in COVID-19: a narrative review. Scientia Medica Porto Alegre 2020; 30: e38030. | CrossRef |
28. Battaglini D, Robba C, Caiffa S, Ball L, Brunetti I, Loconte M, et al. Chest physiotherapy: An important adjuvant in critically ill mechanically ventilated patients with COVID-19. Respir Physiol Neurobiol. 2020 Nov;282:103529. | CrossRef | PubMed |
29. Simpson R, Robinson L. Rehabilitation After Critical Illness in People With COVID-19 Infection. Am J Phys Med Rehabil. 2020 Jun;99(6):470-474. | CrossRef | PubMed |
30. Zhu C, Wu Y, Liu H, Ban Y, Ma X, Zhang Z. Early pulmonary rehabilitation for SARS-CoV-2 pneumonia: Experience from an intensive care unit outside of the Hubei province in China. Heart Lung. 2020 Sep-Oct;49(5):449-450. | CrossRef | PubMed |
31. Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, et al. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. J Physiother. 2020 Apr;66(2):73-82. | CrossRef | PubMed |
32. Yang LL, Yang T. Pulmonary rehabilitation for patients with coronavirus disease 2019 (COVID-19). Chronic Dis Transl Med. 2020 May 14;6(2):79-86. | CrossRef | PubMed |
33. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015 Jan 1;4(1):1. | CrossRef | PubMed |
34. Rada G, Verdugo-Paiva F, Ávila C, Morel Marambio M, Bravo-Jeria R, Pesce F, et al. Evidence synthesis relevant to COVID-19: a protocol for multiple systematic reviews and overviews of systematic reviews. Medwave. 2020 Apr 1;20(3):e7868. English, Spanish. | CrossRef | PubMed |
35. Github repository [Internet] [Accessed 2020 July 14th. | Link |
36. Methods for the special L·OVE of COVID-19. Santiago: Epistemonikos Foundation [On line] | Link |
37. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019 Aug 28;366:l4898. | CrossRef | PubMed |
38. Guyatt GH, Oxman AD, Santesso N, Helfand M, Vist G, Kunz R, et al. GRADE guidelines: 12. Preparing summary of findings tables-binary outcomes. J Clin Epidemiol. 2013 Feb;66(2):158-72. | CrossRef | PubMed |
39. Guyatt GH, Thorlund K, Oxman AD, Walter SD, Patrick D, Furukawa TA, et al. GRADE guidelines: 13. Preparing summary of findings tables and evidence profiles-continuous outcomes. J Clin Epidemiol. 2013 Feb;66(2):173-83. | CrossRef | PubMed |
40. Review Manager (RevMan) [Software]. Version 5.3.5 Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
41. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008 Apr 26;336(7650):924-6. | CrossRef | PubMed |

World Health Organization. Director-General's remarks at the media briefing on 2019-nCoV on 11 February 2020. World Health Organization; 2020. [On line] | Link |

Li LQ, Huang T, Wang YQ, Wang ZP, Liang Y, Huang TB, et al. COVID-19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020 Jun;92(6):577-583. | CrossRef | PubMed |

World Health Organization. [On line] | Link |

World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. [On line] | Link |

Hui DS, I Azhar E, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health - The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020 Feb;91:264-266. | CrossRef | PubMed |

Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020 May;109:102433. | CrossRef | PubMed |

Fang Z, Yi F, Wu K, Lai K, Sun X, Zhong N, et al. Clinical characteristics of Coronavirus Disease 2019 (COVID-9): An updated systematic review. BMJ (2020). | CrossRef |

Nasiri M. COVID-19 clinical charaterisitics, and sex-specific rosk of mortality: systematic review and meta-analysis. BMJ (2020). | CrossRef |

Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020 Mar-Apr;34:101623. | CrossRef | PubMed |

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Apr 30;382(18):1708-1720. | CrossRef | PubMed |

Bai C, Chotirmall SH, Rello J, Alba GA, Ginns LC, Krishnan JA, et al. Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020). Eur Respir Rev. 2020 Oct 5;29(157):200287. | CrossRef | PubMed |

Garrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect. 2020 Dec;81(6):e4-e6. | CrossRef | PubMed |

Weerahandi H, Hochman KA, Simon E, Blaum C, Chodosh J, Duan E, et al. Post-discharge health status and symptoms in patients with severe COVID-19. medRxiv [Preprint]. 2020 Aug 14:2020.08.11.20172742. | CrossRef | PubMed |

Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013 Oct 15;188(8):e13-64. | CrossRef | PubMed |

Nikoletou D, Man WD, Mustfa N, Moore J, Rafferty G, Grant RL, et al. Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests. Disabil Rehabil. 2016;38(3):250-9. | CrossRef | PubMed |

Pinheiro G, Saldías F. Entrenamiento muscular inspiratorio en el paciente con enfermedad pulmonar obstructiva crónica. Rev Chil Enf Respir 2011; 27: 116-123. | CrossRef |

Hilton N, Solis-Moya A. Respiratory muscle training for cystic fibrosis. Cochrane Database Syst Rev. 2018 May 24;5(5):CD006112. | CrossRef | PubMed |

Lau HM, Ng GY, Jones AY, Lee EW, Siu EH, Hui DS. A randomised controlled trial of the effectiveness of an exercise training program in patients recovering from severe acute respiratory syndrome. Aust J Physiother. 2005;51(4):213-9. | CrossRef | PubMed |

COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. | Link |

Zhao HM, Xie YX, Wang C. Recommendations for respiratory rehabilitation in adults with coronavirus disease 2019. Chin Med J (Engl). 2020 Jul;133(13):1595-1602. | CrossRef | PubMed |

Wang TJ, Chau B, Lui M, Lam GT, Lin N, Humbert S. Physical Medicine and Rehabilitation and Pulmonary Rehabilitation for COVID-19. Am J Phys Med Rehabil. 2020 Sep;99(9):769-774. | CrossRef | PubMed |

Candan SA, Elibol N, Abdullahi A. Consideration of prevention and management of long-term consequences of post-acute respiratory distress syndrome in patients with COVID-19. Physiother Theory Pract. 2020 Jun;36(6):663-668. | CrossRef | PubMed |

Bissett B, Gosselink R, van Haren FMP. Respiratory Muscle Rehabilitation in Patients with Prolonged Mechanical Ventilation: A Targeted Approach. Crit Care. 2020 Mar 24;24(1):103. | CrossRef | PubMed |

Elkins M, Dentice R. Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review. J Physiother. 2015 Jul;61(3):125-34. | CrossRef | PubMed |

Qi D, Yan X, Xiang J, Peng J. Effects of early physical and pulmonary rehabilitation for severely and critically ill COVID-19 patients: a retrospective, cohort, and multicenter study. Research square 2020. | CrossRef |

Spruit MA, Holland AE, Singh SJ, Tonia T, Wilson KC, Troosters T. COVID-19: Interim Guidance on Rehabilitation in the Hospital and Post-Hospital Phase from a European Respiratory Society and American Thoracic Society-coordinated International Task Force. Eur Respir J. 2020 Aug 13;56(6):2002197. | CrossRef | PubMed |

Kalirathinam D, Guruchandran R, Subramani P. Comprehensive physiotherapy management in COVID-19: a narrative review. Scientia Medica Porto Alegre 2020; 30: e38030. | CrossRef |

Battaglini D, Robba C, Caiffa S, Ball L, Brunetti I, Loconte M, et al. Chest physiotherapy: An important adjuvant in critically ill mechanically ventilated patients with COVID-19. Respir Physiol Neurobiol. 2020 Nov;282:103529. | CrossRef | PubMed |

Simpson R, Robinson L. Rehabilitation After Critical Illness in People With COVID-19 Infection. Am J Phys Med Rehabil. 2020 Jun;99(6):470-474. | CrossRef | PubMed |

Zhu C, Wu Y, Liu H, Ban Y, Ma X, Zhang Z. Early pulmonary rehabilitation for SARS-CoV-2 pneumonia: Experience from an intensive care unit outside of the Hubei province in China. Heart Lung. 2020 Sep-Oct;49(5):449-450. | CrossRef | PubMed |

Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, et al. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. J Physiother. 2020 Apr;66(2):73-82. | CrossRef | PubMed |

Yang LL, Yang T. Pulmonary rehabilitation for patients with coronavirus disease 2019 (COVID-19). Chronic Dis Transl Med. 2020 May 14;6(2):79-86. | CrossRef | PubMed |

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015 Jan 1;4(1):1. | CrossRef | PubMed |

Rada G, Verdugo-Paiva F, Ávila C, Morel Marambio M, Bravo-Jeria R, Pesce F, et al. Evidence synthesis relevant to COVID-19: a protocol for multiple systematic reviews and overviews of systematic reviews. Medwave. 2020 Apr 1;20(3):e7868. English, Spanish. | CrossRef | PubMed |

Github repository [Internet] [Accessed 2020 July 14th. | Link |

Methods for the special L·OVE of COVID-19. Santiago: Epistemonikos Foundation [On line] | Link |

Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019 Aug 28;366:l4898. | CrossRef | PubMed |

Guyatt GH, Oxman AD, Santesso N, Helfand M, Vist G, Kunz R, et al. GRADE guidelines: 12. Preparing summary of findings tables-binary outcomes. J Clin Epidemiol. 2013 Feb;66(2):158-72. | CrossRef | PubMed |

Guyatt GH, Thorlund K, Oxman AD, Walter SD, Patrick D, Furukawa TA, et al. GRADE guidelines: 13. Preparing summary of findings tables and evidence profiles-continuous outcomes. J Clin Epidemiol. 2013 Feb;66(2):173-83. | CrossRef | PubMed |

Review Manager (RevMan) [Software]. Version 5.3.5 Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008 Apr 26;336(7650):924-6. | CrossRef | PubMed |