Recommendations for respiratory rehabilitation in adults with coronavirus disease 2019

Abstract

Introduction Since December 2019, the coronavirus disease 2019 (COVID-19) has become a public health emergency. COVID-19 has already been classified as a category B infectious disease according to the Law of the People's Republic of China on the Prevention and Treatment of Infectious Diseases, and control measures for category A infectious diseases have been adopted. The National Health Commission has also published diagnosis and treatment protocols to guide the clinical diagnosis and treatment. With the accumulating experience of treating COVID-19 patients, particularly severely and critically ill patients, in clinical practice, our understanding of COVID-19 has continuously deepened. With regard to varying degrees of respiratory, physical, and psychological dysfunction in patients,[1] it is vital to standardize respiratory rehabilitation techniques and procedures for respiratory rehabilitation in various regions. Hence, we combined the opinions of frontline epidemic control experts and reviewed the evidence in relevant literature. Based on the “Coronavirus Disease 2019 Respiratory Rehabilitation Guidelines (First Edition),”[2] we organized experts in evidence-based medicine, respiratory and critical care medicine, and rehabilitation medicine in China, and invited some experts at the frontline of epidemic control in Wuhan and other cities in Hubei province to jointly draft these recommendations. Methodology Registration These recommendations were registered at the International Practice Guidelines Registry Platform (http://www.guidelines-registry.org; registration number: IPGRP-2020CN016). Recommendation work group The recommendation work group was divided into the recommendation drafting group, evidence assessment group, and expert consensus group. The drafting group is responsible for determining the topic and scope of the recommendations, guiding the evidence assessment group in evidence summary, and drafting recommendations. The evidence assessment group is responsible for searching, assessing, and providing a summary of relevant evidence. The expert consensus group is responsible for achieving a consensus from the preliminary recommendations. Literature search Our recommendations included rehabilitation-related guidelines, systemic reviews, and randomized controlled trials with regard to three infectious diseases (COVID-19, severe acute respiratory syndrome [SARS], and Middle East respiratory syndrome [MERS]). Two members of the evidence assessment team performed independent computer searches of English databases (PubMed, Ovid, Embase), Chinese databases (Chinese Biological Medical Literature database, China National Knowledge Infrastructure, Chinese Medical Journal Database), and relevant online website bulletins on COVID-19 (the World Health Organization, Elsevier, the Lancet, the New England Journal of Medicine, and the Journal of the American Medical Association, 2019 Novel Coronavirus Resource (2019nCoVR), and the Chinese Medical Journal Network). The search period was from database construction to February 21, 2020. The search terms included the English terms and their Chinese equivalents: “novel coronavirus pneumonia,” “NCP,” “severe acute respiratory syndrome,” “SARS,” “Middle East Respiratory Syndrome,” “MERS,” “influenza,” “psychological therapy,” “guideline,” “statement,” “recommendation,” “randomized controlled trial,” and other rehabilitation-related English search terms and their Chinese equivalents included “respiratory rehabilitation,” “pulmonary rehabilitation,” “physiotherapy,” “physical therapy,” and “occupational therapy.” If the complete article was unavailable, we emailed the corresponding author to obtain it. Paper screening and evidence summary Two members of the evidence assessment group used the Endnote X9 literature management software to screen the literature independently according to the inclusion and exclusion criteria. Different rehabilitation topics were used for classification and to summarize the results of the included articles. Cross-verification was carried out by two staff members during screening and during the preparation of the summary. If there was any dispute, a third researcher intervened, discussed, and resolved the dispute. Quality assessment The evidence assessment group employed the Appraisal of Guidelines for Research & Evaluation II tool for methodological quality assessment of the included guidelines, the Assessment of Multiple Systematic Reviews tool for quality assessment of systematic reviews, and the Cochrane bias risk assessment tool for bias risk assessment of randomized controlled trials. Generation of recommendations and consensus Based on the evidence summary and quality assessment results, the recommendation drafting group combined all existing recommendations and drafted a preliminary version of rehabilitation recommendations. The recommendations were submitted to the expert consensus group, and a consensus was reached through panel discus