The Effect of Convalescent Plasma Therapy on Mortality Among Patients With COVID-19: Systematic Review and Meta-analysis

To determine the effect of COVID-19 convalescent plasma on mortality, we aggregated patient outcome data from 10 randomized clinical trials, 20 matched control studies, 2 dose-response studies, and 96 case reports or case series. Studies published between January 1, 2020, and January 16, 2021, were identified through a systematic search of online PubMed and MEDLINE databases. Random effects analyses of randomized clinical trials and matched control data demonstrated that patients with COVID-19 transfused with convalescent plasma exhibited a lower mortality rate compared with patients receiving standard treatments. Additional analyses showed that early transfusion (within 3 days of hospital admission) of higher titer plasma is associated with lower patient mortality. These data provide evidence favoring the efficacy of human convalescent plasma as a therapeutic agent in hospitalized patients with COVID-19.     

Effectiveness of Therapeutic Exercise Models on Cancer-Related Fatigue in Patients With Cancer Undergoing Chemotherapy: A Systematic Review and Network Meta-analysis

ObjectiveTo assess and compare the effectiveness of different exercise modalities in reducing cancer-related fatigue (CRF) in patients with cancer undergoing chemotherapy. Exercise intensities for selected exercise types were also compared.Data SourcesWe conducted a search in MEDLINE, Embase, CINAHL, Scopus, SPORTDiscus, and Web of Science from inception to October 15, 2021.Study SelectionRandomized controlled trials concerning the effectiveness of exercise modalities on CRF in patients with cancer undergoing chemotherapy were included.Data ExtractionStudy characteristics were extracted using a structured protocol. Methodological quality was assessed employing the PEDro scale and risk of bias was assessed using the Revised Cochrane Risk of Bias Tool for Randomized Trials. The certainty of evidence was assessed based on Grading of Recommendations, Assessment, Development and Evaluation. The measure of effect used was the adjusted standardized mean difference (SMD) or Hedge's g, together with the corresponding 95% confidence intervals (CI).Data SynthesisForty-seven studies were included. Data were pooled employing a random-effects model. There was a trend that adding low-intensity aerobic and resistance exercise (SMD=1.28, 95% CI -0.18; 2.75, P=.086), or moderate-intensity aerobic and resistance exercise (SMD=0.85; 95% CI -0.12; 1.82, P=.087), was more effective than adding flexibility training to usual care (UC). There was also a trend that UC alone was less effective than adding moderate-intensity aerobic and resistance exercise (SMD=-0.47, 95% CI -0.96, 0.02, P=.060) to UC.ConclusionsThe addition of low- to moderate-intensity aerobic and/or resistance exercise demonstrated a positive trend for improvement in CRF in patients with cancer undergoing chemotherapy, when compared with UC alone or UC with flexibility training.     

The Impact of Exercise during Radiation Therapy for Prostate Cancer on Fatigue and Quality of Life: A Systematic Review and Meta-analysis

BackgroundRadiation therapy (RT) is clinically proven to improve survival in men with prostate cancer. Despite these advantages, it is known to cause adverse effects such as fatigue. This review proposes to summarize the totality of evidence from randomized controlled trials regarding the effectiveness of exercise on fatigue in men with prostate cancer as a primary outcome. Quality of life was a secondary outcome.MethodsRCTs that explored the effect of exercise during RT on fatigue for men with prostate cancer were searched using MEDLINE, Embase, CINAHL, Cochrane Library, AMED, ClinicalTrials.gov, and ISRTCN registry. Reference lists of included studies and reviews were also examined. Trials were excluded if they included a mixed cohort of patients where data could not be extracted for prostate cancer patients alone or if the intervention took place after RT had finished. Preferred Reporting Items for Systematic Reviews and Meta-Analyses standardized reporting guidelines were followed to ensure the standardised conduct and reporting of the research.ResultsThe search strategy yielded a total of 278 studies, of which five met the inclusion criteria. A meta-analysis pooled data of 392 participants using the Cochrane Review Manager 5.3 random-effects model (DerSimonian-Laird approach) with the post-test means of the control and intervention groups and associated standard deviations. Exercise was significant at alleviating fatigue when compared to the control group (standardized mean differences, −1.03; 95% confidence interval, −1.82 to −0.24).ConclusionExercise during RT is an effective approach to alleviate fatigue in men with prostate cancer. The effect on quality of life was not significant, possibly because of considerable heterogeneity across studies.     

Effects of Exercise Training on Restless Legs Syndrome,Depression, Sleep Quality,and Fatigue Among Hemodialysis Patients: A Systematic Review and Meta-analysis

Context

Hemodialysis (HD) patients experience a heavy symptom burden that leads to a decreased quality of life. Pharmacological treatment is effective but costly and has adverse effects. Exercise is a promising approach for symptom management, but the effect of exercise on restless legs syndrome (RLS), depression, sleep quality, and fatigue in HD patients is still uncertain.

Effectiveness of Pulmonary Rehabilitation in Exercise Capacity and Quality of Life in Chronic Obstructive Pulmonary Disease Patients With and Without Global Fat-Free Mass Depletion

Objective

To investigate the effectiveness of pulmonary rehabilitation (PR) in exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD) with and without global fat-free mass (FFM) depletion.

Design

Retrospective case-control.

Setting

Outpatient clinic, university center.

Participants

COPD patients (N=102) that completed PR were initially evaluated.

Intervention

PR including whole-body and weight training for 12 weeks, 3 times per week.

Main Outcome Measures

St. George Respiratory Questionnaire (SGRQ), 6-minute walk distance (6MWD), and FFM evaluation applied before and after PR.

Results

Patients were stratified according to their FFM status measured by bioelectric impedance. They were considered depleted if the FFM index was ≤15kg/m² in women and ≤16kg/m² in men. From the initial sample, all depleted patients (n=31) composed the FFM depleted group. It was composed predominantly by women (68%) with a mean age ± SD of 64.4±7.3 years and a forced expiratory volume in 1 second of 33.6%=−13.2% predicted. Paired for sex and age, 31 nondepleted patients were selected from the initial sample to compose the nondepleted group. Improvement in the 6MWD was similar in these 2 groups after PR. Both groups improved SGRQ scores, although the observed power was small and did not allow adequate comparison between depleted and nondepleted patients. There was no difference between groups in weight change, whereas FFM tended to be greater in depleted patients. This increase had no correlation with the 6MWD or the SGRQ.

Conclusions

Benefits of PR to exercise capacity were similar comparing FFM depleted and nondepleted COPD patients. Although FFM change tended to be greater in depleted patients, this increase had no definite relation with clinical outcomes.     

Nonpharmacologic Interventions for Improving Sleep Disturbances in Patients With Lung Cancer: A Systematic Review and Meta-analysis

Context

Lung cancer patients experience higher levels of sleep disturbances compared to other cancer patients, and this leads to greater distress, poorer function, and lower quality of life. Nonpharmacologic interventions have demonstrated improvements in the context of breast cancer, but their efficacy in the lung cancer population is unclear.

正念干预改善运动员心理康复效果的系统综述和Meta分析

目的 综合评价正念干预对运动员心理康复的效果。方法 检索2010年1月1日至2019年12月31日Web of Science、EBSCO、PubMed、Medline、OpenDissertations、Psychology and Behavioral Sciences Collection、Academic Search Premier、中国知网(CNKI)、维普和万方数据库有关正念干预促进运动员心理康复的研究,对纳入文献进行质量评价,采用Review Manager 5.3软件进行Meta分析。结果 共纳入18项研究。正念干预对运动员心理康复即刻效果呈中到大效应量(d= 0.69, 95%CI 0.53~0.86, P< 0.001),但存在发表偏倚。正念组干预的追踪效应量不显著(d= -0.08, 95%CI -0.33~0.16, P= 0.50)。正念干预的康复效果受研究质量的影响(I² = 88.1%, P= 0.004)。结论 正念干预对运动员心理康复的效果主要表现为改善心境,促进流畅体验,提高消极体验的接受性,提高对目标的行动力和提高训练的投入程度。正念干预效果受研究质量的影响。     

Differential Effects of the COVID-19 Pandemic on Physical Activity Involvements and Exercise Habits in People With and Without Chronic Diseases: A Systematic Review and Meta-analysis

ObjectiveTo conduct a systematic review and meta-analysis to summarize evidence regarding differential changes in physical activity (PA) involvements and exercise habits in people with and without chronic diseases during the COVID-19 outbreak.Data SourcesMEDLINE, Embase, SPORTDiscus, Cumulative Index to Nursing and Allied Health, PsycINFO, Cochrane Library, and Physiotherapy Evidence Database were searched from November 2019 to May 2021.Study SelectionTwo reviewers independently screened cross-sectional and longitudinal studies that investigated changes in PA-related outcomes in people with and without chronic diseases during the pandemic.Data ExtractionPA-related outcomes and sedentary time were extracted from the included studies. Relevant risk of bias were assessed. Meta-analyses were conducted for each PA-related outcome, if applicable. Quality of evidence of each PA-related outcome was evaluated by Grading of Recommendations Assessment, Development, and Evaluation.Data SynthesisOf 1226 identified citations, 36 articles (28 with and 8 without chronic diseases) with 800,256 participants were included. Moderate evidence from wearable sensors supported a significant reduction in pooled estimates of step count (standardized mean differences [SMD]=?2.79, P<.01). Very limited to limited evidence substantiated significant decreases in self-reported PA-related outcomes and significant increases in sedentary behaviors among people with and without chronic diseases. Specifically, pooled estimates of metabolic equivalent-minute per week (SMD=?0.16, P=.02) and PA duration (SMD=?0.07, P<.01) were significantly decreased, while sedentary time (SMD=0.09, P=.04) showed significant increases in the general population (small to large effects). Very limited evidence suggested no significant PA changes among people in a country without lockdown.ConclusionsDuring the pandemic, objective and self-reported assessments showed significant reductions in PA in people with and without chronic diseases globally. This mainly occurred in countries with lockdowns. Although many countries have adopted the “live with the coronavirus” policy, authorities should implement population-based strategies to revert the potential lockdown-related long-term deleterious effects on people's health.     

Efficacy of Robot-Assisted Training on Rehabilitation of Upper Limb Function in Patients With Stroke: A Systematic Review and Meta-analysis

ObjectiveTo systematically evaluate the effect of robot-assisted training (RAT) on upper limb function recovery in patients with stroke, providing the evidence-based medical basis for the clinical application of RAT.Data SourcesWe searched online electronic databases up to June 2022, including PubMed, The Cochrane Library, Scopus, Web of Science, EMBASE, WanFang Data, CNKI, and VIP full-text databases.Study SelectionRandomized controlled trials of the effect of RAT on upper extremity functional recovery in patients with stroke.Data ExtractionThe Cochrane Collaboration Tool for Assessing the Risk of Bias was used to assess study quality and risk of bias.Data SynthesisFourteen randomized controlled trials involving 1275 patients were included for review. Compared with the control group, RAT significantly improved upper limb motor function and daily living ability. The overall differences were statistically significant, Fugl-Meyer Assessment for the Upper Extremity (FMA-UE; standard mean difference=0.69; 95% confidence interval, 0.34, 1.05; P=.0001), modified Barthel Index (standard mean difference=0.95; 95% confidence interval, 0.75, 1.15; P<.00001), whereas the differences in modified Ashworth Scale, FIM, and Wolf Motor Function Test scores were not statistically significant.Subgroup AnalysisCompared with the control group, the differences between FMA-UE and modified Barthel Index at 4 and 12 weeks of RAT, there were statistically significant, the differences of FMA-UE and modified Ashworth Scale in patients with stroke in the acute and chronic phases were statistically significant.ConclusionThe present study showed that RAT can significantly enhance the upper limb motor function and activities of daily life in patients with stroke undergoing upper limb rehabilitation.     

八段锦对脑卒中患者肢体功能康复影响的Meta分析

目的系统评价八段锦对脑卒中患者肢体功能康复的影响。方法计算机检索Pubmed、Cochrane图书馆、中国生物医学数据库、万方数据库等,纳入符合标准的随机对照试验,检索时间为建库至2016年11月。纳入文献的方法学质量采用Cochrane偏倚风险评估工具进行评价。应用RevMan 5.3统计软件进行Meta分析。结果最终纳入6篇文献,共涉及443名研究对象。Meta分析结果显示,八段锦组与对照组相比能改善脑卒中患者的平衡功能;八段锦联合平衡功能训练可改善下肢运动功能;八段锦联合常规健康指导或康复治疗,可改善脑卒中患者的日常生活活动能力和神经功能缺损状况。结论八段锦在一定程度上能够促进脑卒中患者肢体功能的康复,但需进一步在大样本中验证其有效性。     

Factors Associated With Fatigue in People With Spinal Cord Injury: A Systematic Review and Meta-analysis

ObjectiveTo investigate the association between fatigue and clinical and demographic variables in people with spinal cord injury (SCI).Data SourcesFive databases (MEDLINE, Physiotherapy Evidence Database, Cochrane, Google Scholar, Cumulative Index to Nursing and Allied Health) were searched up to November 2021.Study SelectionObservational studies that reported the association between fatigue and clinical and demographic variables in English or Spanish were eligible. Reviews, qualitative research studies, and nonoriginal articles were excluded. Twenty-three of the 782 identified studies met the inclusion criteria for the meta-analysis.Data ExtractionTwo researchers independently extracted the data. The strength of the association between each factor and fatigue was determined by the effect size. When the results of the effect size were expressed with different statistics, the correlation coefficient was the preferred estimation. The risk of bias was assessed using the Appraisal Tool for Cross-Sectional Studies and the Newcastle-Ottawa Scale.Data SummaryA pooled analysis of the associations between fatigue and 17 factors was performed. A direct association was found between fatigue and 9 factors (sorted by effect size): anxiety (r=0.57; 95% CI, 0.29-0.75), stress (r=0.54; 95% confidence interval [CI], 0.26-0.74), depression (r=0.47; 95% CI, 0.44-0.50), pain (r=0.34; 95% CI, 0.16-0.50), analgesic medication (r=0.32; 95% CI, 0.28-0.36), assistive devices (r=0.23; 95% CI, 0.17-0.29), lesion level (r=0.15; 95% CI, 0.07-0.23), incomplete SCI (r=0.13; 95% CI, 0.05-0.22), and medication (r=0.12; 95% CI, 0.01-0.23). An inverse association was found with 3 factors (sorted by effect size): self-efficacy (r=?0.63; 95% CI, ?0.81 to ?0.35), participation (r=?0.32; 95% CI, ?0.58 to ?0.001), and physical activity (r=?0.17; 95% CI, ?0.28 to ?0.05). No association was found with age, sex, educational level, time since injury, and spasticity.ConclusionsSeveral factors were associated with fatigue in people with SCI, with those related to mental health showing the strongest associations. These results should be interpreted with caution because of the high heterogeneity observed in some factors.     

Is Fatigue Associated With Aerobic Capacity and Muscle Strength in People With Multiple Sclerosis: A Systematic Review and Meta-analysis

ObjectiveTo determine the relationship between self-reported fatigue and aerobic capacity and muscle strength in people with multiple sclerosis (MS).Data SourcesFour databases (Cumulative Index to Nursing and Allied Health, MEDLINE, ProQuest, and Web of Science Core Collections) were searched up to October 2018.Study SelectionCross-sectional or longitudinal studies that reported the association between self-reported fatigue and aerobic capacity or objectively measured muscle strength in people with MS were included.Data ExtractionStudy details, participant demographics, outcome measurement protocols, and the correlation coefficient derived from the association between fatigue and aerobic capacity or muscle strength at baseline was extracted, and methodological quality of included studies was assessed using the Joanna Briggs Institute Appraisal Checklist for Analytical Cross-sectional Studies.Data SynthesisTen studies were identified, of which 5 examined the association between fatigue and aerobic capacity and 7 examined the association between fatigue and muscle strength. Meta-analysis of the extracted correlation coefficients was performed using the Hedges-Olkin method, and pooled correlation coefficients demonstrated a moderate negative association between fatigue and aerobic capacity (r=−0.471; 95% CI, −0.644 to −0.251; P<.001) and a weak negative association between fatigue and muscle strength (r=−0.224; 95% CI, −0.399 to −0.032; P=.022).ConclusionsThe results of this meta-analysis suggest that higher levels of aerobic capacity are associated with lower fatigue. Therefore, this finding highlights the potential role of aerobic exercise interventions in managing fatigue. Conversely, the relationship between fatigue and muscle strength was weak and inconsistent, and further studies are required to examine the association between these variables.     

The Relationship Between Fatigue and Quality of Life in Children With Chronic Health Problems: A Systematic Review

PURPOSE: This systematic review synthesized the literature regarding fatigue in children with chronic health problems and examined the relationship to quality of life. CONCLUSIONS: Most studies that have examined fatigue and its relationship to quality of life in children with chronic health problems have focused on children with cancer. Studies found that children often reported fatigue and that it decreased quality of life. PRACTICE IMPLICATIONS: Quantifying fatigue in children with chronic illnesses and disabilities is critical for pediatric nursing assessment. Understanding the impact of fatigue on children with chronic health problems is a first step in improving their quality of life.     

Prevalence of Fatigue in Patients With Cancer: A Systematic Review and Meta-Analysis

ContextFatigue is a particularly common and troubling symptom that has a negative impact on quality of life throughout all phases of treatment and stages of the illness among patients with cancer.ObjectivesThe objective of this meta-analysis is to examine the present status of fatigue prevalence in patients with cancer.MethodsThe following databases were searched: PubMed, MEDLINE, EMBASE, PsycINFO, Cochrane Library, from inception up to February 2020. Prevalence rates were pooled with meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I²) statistics.ResultsA total of 129 studies (N = 71,568) published between 1993 and 2020 met the inclusion criteria. The overall prevalence of fatigue was 49% (34,947 of 71,656 participants, 95% CI = 45–53) with significant heterogeneity between studies (P < 0.000; τ² = 0.0000; I² = 98.88%). Subgroup analyses show that the prevalence of fatigue related to type of cancer ranged from 26.2% in patients with gynecological cancer to 56.3% in studies that included mixed types of cancer. In advanced cancer stage patients, the highest prevalence of fatigue (60.6%) was reported. Fatigue prevalence rates were 62% during treatment and 51% during mixed treatment status. The prevalence of fatigue decreased from 64% in studies published from 1996 to 2000 to 43% in studies published from 2016 to 2020. Metaregression identified female gender as a significant moderator for higher prevalence of fatigue, whereas mean age is not associated with fatigue.ConclusionThis meta-analysis highlights the importance of developing optimal monitoring strategies to reduce fatigue and improve the quality of life of patients with cancer.     

Effectiveness of Continuous Chest Wall Vibration With Concurrent Aerobic Training on Dyspnea and Functional Exercise Capacity in Patients With Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

ObjectiveTo investigate the effects of continuous chest wall vibration with concurrent aerobic training in addition to a 4-week pulmonary rehabilitation program on dyspnea and functional exercise capacity in patients with chronic obstructive pulmonary disease (COPD).DesignRandomized, single-blind, placebo-controlled trial.SettingThe Cardiopulmonary Rehabilitation Unit of a tertiary referral subacute rehabilitation center.ParticipantsA sample of 146 consecutive patients with COPD (Global Initiative for Chronic Obstructive Lung Disease II-III-IV) were assessed for eligibility. The final sample of 40 patients (N=40) was randomized into 3 groups (intervention, sham intervention, control).InterventionsAll groups carried out 5 sessions per week for 4 weeks of standard pulmonary rehabilitation treatment. The 2 daily 30-minute sessions included aerobic training and resistance training or airway clearance techniques. The intervention group performed the aerobic training with the addition of continuous chest wall vibration applied during cycling, whereas the sham intervention group received continuous chest wall vibration as a placebo during cycling.Main Outcome MeasuresSix-minute walk distance (6MWD) and Barthel Index based on dyspnea (BID).ResultsA total of 36 participants completed the study (69±7 years; forced expiratory volume in 1 second percentage of predicted, 40.15%±15.97%). Intention to treat analysis showed no significant differences between groups for 6MWD and BID. However, the increase in 6MWD was a clinically important difference in the intervention group (42.57±43.87m, P=.003), with a moderate effect size (d=0.58).ConclusionsContinuous chest wall vibration with concurrent aerobic training in addition to a standard pulmonary rehabilitation program might improve functional exercise capacity compared with usual care, but there were no effects on dyspnea, respiratory muscle function, or quality of life in patients with COPD.     

Efficacy of Vestibular Rehabilitation in Patients With Neurologic Disorders: A Systematic Review

ObjectiveThe aim of this systematic review is to critically assess the effectiveness of vestibular rehabilitation (VR) administered either alone or in combination with other neurorehabilitation strategies in patients with neurologic disorders.Data SourcesAn electronic search was conducted by 2 independent reviewers in the following databases: MEDLINE (PubMed), the Physiotherapy Evidence Database, and the Cochrane Database of Systematic Reviews.Study SelectionAll clinical studies carried out on adult patients with a diagnosis of neurologic disorders who performed VR provided alone or in combination with other therapies were included.Data ExtractionScreening of titles, abstracts, and full texts and data extraction were undertaken independently by pairs of reviewers. Included studies were quality appraised using a modified version of the Newcastle-Ottawa Scale.Data SynthesisThe summary of results was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Twelve studies were included in the review. All the included studies, with 1 exception, report that improvements provided by customized VR in subject affected by a central nervous system diseases are greater than traditional rehabilitation programs alone.ConclusionsBecause of the lack of high-quality studies and heterogeneity of treatments protocols, clinical practice recommendations on the efficacy of VR cannot be made. Results show that VR programs are safe and could easily be implemented with standard neurorehabilitation protocols in patients affected by neurologic disorders. Hence, more high-quality randomized controlled trials of VR in patients with neurologic disorders are needed.     

Efficacy of Exercise Interventions in Patients With Advanced Cancer: A Systematic Review

Objective

To critically analyze the literature surrounding the efficacy of exercise interventions in patients with advanced cancer.

护士健康指导下的肺康复对老年慢性阻塞性肺疾病患者肺功能和生活质量的影响

目的探讨门诊护士健康指导下的肺康复对老年慢性阻塞性肺疾病(COPD)患者运动耐力、生活质量及肺功能的影响。方法对54 例门诊COPD稳定期老年患者实施健康指导下的康复锻炼3 个月,分别在干预前后对患者进行呼吸困难及疲劳程度评定(采用Borg 评分)、肺功能测定、6 min 步行距离评定和生活质量评分。结果干预后,患者呼吸困难及疲劳程度有所改善,6 min 步行距离明显增加(P<0.01);生活质量各维度评分明显提高(P<0.01);肺功能未见明显改善(P>0.05)。结论门诊护士健康指导下的肺康复能提高COPD稳定期老年患者运动耐力和生活质量。