A systematic review of exercise studies for individuals hospitalized with an acute exacerbation of chronic obstructive pulmonary disease: Focus on the principles of exercise training.

BACKGROUND: For exercise interventions to be effectively reproduced or applied in a "real world" clinical setting, clinical trials must thoroughly document all components of the exercise prescription and ensure that participants adhere to each component. However, previous reviews have not critically examined the quality of exercise prescription of inpatient Pulmonary Rehabilitation (PR) programs. OBJECTIVE: The objectives of this review were to evaluate the (a) application of the principles of exercise training, (b) reporting of the frequency, intensity, time and type (FITT) components of exercise prescription, and (c) reporting of patient's adherence to the FITT components in intervention studies for patients admitted to hospital for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: Relevant scientific databases were searched for randomized controlled trials (RCTs) that compared in-hospital PR with usual care for people hospitalized with AECOPD. Title and abstract followed by full-text screening were conducted independently by two reviewers. Data were extracted and synthesized to evaluate the application of the principles of exercise training and the reporting/adherence of the FITT components. RESULTS: Twenty-seven RCTs were included. Only two applied all principles of exercise training. Specificity was applied by 70%, progression by 48%, overload by 37%, initial values by 89% and diminishing returns and reversibility by 37% of trials. Ten trials adequately reported all FITT components. Frequency and type were the components most reported (85% and 81%, respectively), while intensity was less frequently reported (52%). Only three trials reported on the patient's adherence to all four components. CONCLUSIONS: Studies have not adequately reported the exercise prescription in accordance with the principles of exercise training nor reported all the FITT components of the exercise prescription and patient's adherence to them. Therefore, interpretation of the current literature is limited and information for developing exercise prescriptions to individuals hospitalized with an AECOPD is lacking.

Scoping review of telehealth use by Indigenous populations from Australia, Canada, New Zealand, and the United States.

INTRODUCTION: Telehealth has the potential to address health disparities experienced by Indigenous people, especially in remote areas. This scoping review aims to map and characterize the existing evidence on telehealth use by Indigenous people and explore the key concepts for effective use, cultural safety, and building therapeutic relationships. METHODS: A search for published and gray literature, written in English, and published between 2000 and 2022 was completed in 17 electronic databases. Two reviewers independently screened retrieved records for eligibility. For included articles, data were extracted, categorized, and analyzed. Synthesis of findings was performed narratively. RESULTS: A total of 321 studies were included. The most popular type of telehealth used was mHealth (44%), and the most common health focuses of the telehealth interventions were mental health (26%) and diabetes/diabetic retinopathy (13%). Frequently described barriers to effective telehealth use included concerns about privacy/confidentiality and limited internet availability; meanwhile, telehealth-usage facilitators included cultural relevance and community engagement. Although working in collaboration with Indigenous communities was the most frequently reported way to achieve cultural safety, 40% of the studies did not report Indigenous involvement. Finally, difficulty to establish trusting therapeutic relationships was a major concern raised about telehealth, and evidence suggests that having the first visit-in-person is a potential way to address this issue. CONCLUSION: This comprehensive review identified critical factors to guide the development of culturally-informed telehealth services to meet the needs of Indigenous people and to achieve equitable access and positive health outcomes.

Safety and Efficacy of Inpatient Pulmonary Rehabilitation for Patients Hospitalized with an Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-analyses.

Rationale: Pulmonary rehabilitation (PR) during hospitalization for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) occurs during a period of disease instability for the patient, and the safety and efficacy of PR, specifically during the hospitalization period, have not been established. Objective: The purpose of this review is to determine the safety and efficacy of PR during the hospitalization phase for individuals with AECOPD. Methods: Scientific databases were searched up to August 2022 for randomized controlled trials that compared in-hospital PR with usual care. PR programs commenced during the hospitalization and included a minimum of two sessions. Titles and abstracts followed by full-text screening and data extraction were conducted independently by two reviewers. The intervention effect estimates were calculated through meta-analysis using a random-effect model. Results: A total of 27 studies were included (n = 1,317). The meta-analysis showed that inpatient PR improved the 6-minute-walk distance by 105 m (P < 0.001). Inpatient PR improved the performance on the five-repetition sit-to-stand test by -7.02 seconds (P = 0.03). Quality of life (QOL), as measured by the 5-level EuroQoL Group-5 dimension version (EQ-ED-5L) and the St. George's Respiratory Questionnaire, was significantly improved by the intervention. Inpatient PR increased lower limb muscle strength by 33.35 N (P < 0.001). There was no change in the length of stay. Only one serious adverse event related to the intervention was reported. Conclusions: This review suggests that it is safe and effective to provide PR during hospitalization for individuals with AECOPD. In-hospital PR improves functional exercise capacity, QOL, and lower limb strength without prolonging the hospital length of stay.

How is resilience conceptualized and operationalized in occupational therapy and occupational science literature? Protocol for a scoping review / Como a resiliência é conceituada e operacionalizada na literatura de ciência ocupacional e terapia ocupacional? Protocolo para uma revisão de escopo

Abstract Introduction Resilience is a commonly discussed term describing the ability to overcome, adapt to, or cope with stressful/disruptive events. Although researchers and practitioners define resilience in diverse ways - e.g., psychological or disaster resilience - the concept fundamentally encompasses perseverance through adversity. As experts in the interplay between individuals, environments, and occupations, occupational therapists and occupational scientists have great potential to understand and enable resilience, with some similar concepts appearing in occupational theories (e.g., occupational adaptation). However, there are no published reviews of resilience in the occupation-focused literature. Objective We will explore how resilience is conceptualized and operationalized in the occupational therapy and occupational science research literature. Method Guided by the Joanna Briggs Institute scoping review methodology, we will search library databases and other sources for relevant records. Two team members will screen records for inclusion, with discrepancies settled by a third person. We will include English-language literature (including research papers, editorials, dissertations, etc.) published since 1990 which 1) contains the word root 'resilien*' and 2) is occupation focused, according to our criteria (occupational therapist/occupational scientist co-authors or research participants; and/or published in occupation-focused periodical). We will report key information of included literature, such as methodology and resilience theories discussed. Results Our study is ongoing at the time of publication; this manuscript reports its protocol without results. Conclusion Findings will be useful for clinicians and researchers looking for occupational conceptualizations of resilience. From a social justice perspective, our review may highlight evidence that occupational engagement can foster resilience among marginalized communities.

Resumo Introdução Resiliência é um termo que descreve a habilidade de superar, adaptar ou lidar com eventos estressantes ou perturbadores. Embora pesquisadores e profissionais definam resiliência de diversas maneiras - como resiliência psicológica ou a desastres - o conceito fundamentalmente engloba perseverança no enfrentamento de adversidades. Como especialistas na interação entre indivíduos, comunidades, ambientes e ocupações, terapeutas ocupacionais e cientistas ocupacionais têm potencial para compreender e propiciar a resiliência, com alguns conceitos semelhantes (como adaptação ocupacional). Entretanto, não há nenhuma revisão publicada sobre resiliência na área. Objetivo Explorar como a resiliência é conceituada e operacionalizada na literatura científica de terapia ocupacional e ciência ocupacional. Método Guiados pela metodologia para revisões de escopo proposta pelo Instituto Joanna Briggs, buscou-se por documentos em bases de dados científicas e outras fontes. Dois membros da equipe revisaram documentos para inclusão e as discrepâncias foram resolvidas por uma terceira pessoa. Utilizou-se literatura em inglês (artigos de pesquisa, editoriais, dissertações etc.) publicada desde 1990 que: (1) contenha 'resilien*' e (2) seja focada na ocupação, desde que: terapeutas ocupacionais ou cientistas ocupacionais fossem coautores ou participantes da pesquisa; e/ou publicada em periódico focado em terapia ocupacional/ciência ocupacional. Foram reportadas as principais informações dos documentos incluídos, como a metodologia e as teorias de resiliência. Resultados Este estudo está em andamento; foca-se aqui no protocolo de pesquisa, sem resultados. Conclusão As discussões serão úteis para profissionais na prática clínica e pesquisadores buscando por uma conceituação ocupacional de resiliência. De uma perspectiva de justiça social, essa revisão pode destacar evidências de que o engajamento com ocupações pode promover resiliência entre comunidades marginalizadas.

Virtual Care for Indigenous Populations in Canada, the United States, Australia, and New Zealand: Protocol for a Scoping Review.

BACKGROUND: Indigenous people in Canada, the United States, Australia, and New Zealand experience an increased burden of chronic diseases compared to non-Indigenous people in these countries. Lack of necessary services and culturally relevant care for Indigenous people contributes to this burden. Many Indigenous communities have implemented systems, such as virtual care, to improve chronic disease management. Virtual care has extended beyond videoconferencing to include more advanced technologies, such as remote biometric monitoring devices. However, given the historical and ongoing Western intrusion into Indigenous day to day life, these technologies may seem more invasive and thus require additional research on their acceptability and utility within Indigenous populations. OBJECTIVE: The objective of this paper is to present the protocol for a scoping review, which aims to map existing evidence. This study is based on the following guiding research question: What are the characteristics of virtual care use by Indigenous adult populations in Canada, the United States, Australia, and New Zealand? The subquestions are related to the technology used, health conditions and nature of the virtual care, cultural safety, and key concepts for effective use. METHODS: This scoping review protocol is informed by the methodology described by the Joanna Briggs Institute and is supplemented by the frameworks proposed by Arksey and O'Malley and Levac et al. A search for published and gray literature, written in English, and published between 2000 and present will be completed utilizing electronic databases and search engines, including MEDLINE, CINAHL, Embase, Indigenous Peoples of North America, Australian Indigenous HealthInfoNet, Informit, and Native Health Database. Search results will be uploaded to the review software, Covidence, for title and abstract screening before full-text screening begins. This process will be repeated for gray literature. Upon completion, a data abstraction tool will organize the relevant information into categorical formations. RESULTS: The search strategy has been confirmed, and the screening of titles and abstracts is underway. As of October 2020, we have identified over 300 articles for full-text screening. CONCLUSIONS: Previous reviews have addressed virtual care within Indigenous communities. However, new virtual care technologies have since emerged; subsequently, additional literature has been published. Mapping and synthesizing this literature will inform new directions for research and discussion. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/21860.