Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19: a quasi-experimental study

Classified as probably not a substantial claim.

Respiratory rehabilitation was recommended only for patients with moderate to severe COVID-19-related respiratory symptoms.

“The study included only the patients with moderate to severe COVID-19-related respiratory symptoms because respiratory rehabilitation was recommended only for these patients according to previous literature [15–18].”

• cites [15] Lazzeri M, Lanza A, Bellini R, et al. Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Arch Chest Dis. 2020. https://doi.org/10.4081/monaldi.2020.1285. sourceCould not verify

  The paper’s “Procedures NOT to be applied in the Acute Phase” section discourages several respiratory physiotherapy techniques during acute COVID-19, while its “7th ADVICE” discusses mobilization as sedation is reduced. Neither section states that respiratory rehabilitation is recommended only for patients with moderate-to-severe respiratory symptoms. Searches for that severity threshold and for recommendations concerning mild cases found no such passage in our copy. (LLM, conf=0.76)

  Experimental — accuracy not yet measured
• cites [16] Zhao H-M, Xie Y-X, Wang C. Recommendations for respiratory rehabilitation in adults with COVID-19. Chin Med J. 2020;133:1595–602. sourceDisputed

  The paper does not limit respiratory rehabilitation recommendations to patients with moderate to severe symptoms. Its section on mildly ill patients during hospitalization recommends breathing exercises and other activities (page not available in our copy). (LLM, conf=0.89)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured
• cites [17] Felten-Barentsz KM, van Oorsouw R, Klooster E, et al. Recommendations for hospital-based physical therapists managing patients with COVID-19. Phys Ther. 2020;100(9):1444–57. sourcePartly supported

  The Scope and Treatment sections focus respiratory-support recommendations on hospitalized patients who are severely or critically ill with COVID-19. They do not recommend respiratory rehabilitation for patients with moderate symptoms as a group or state that it is recommended only for patients with moderate-to-severe respiratory symptoms. Page numbers are unavailable in our copy. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [18] Abdullahi A. Safety and efficacy of chest physiotherapy in patients with COVID-19: a critical review. Front Med. 2020;7:454. sourceDisputed

  The Introduction says chest physiotherapy can be used for patients with mild to moderate symptoms. The ‘Chest Physiotherapy During the Acute Period’ section also discusses its case-by-case use for patients with exudation and mild to moderate symptoms. This contradicts the claim that respiratory rehabilitation was recommended only for those with moderate to severe symptoms. Page numbers were not supplied. (LLM, conf=0.90)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Both scientific and anecdotal reports have highlighted the importance of breathing exercises for maintaining respiratory function [15-18].

“Both scientific and anecdotal reports have highlighted the importance of breathing exercises for maintaining respiratory function [15–18].”

• cites [15] Lazzeri M, Lanza A, Bellini R, et al. Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Arch Chest Dis. 2020. https://doi.org/10.4081/monaldi.2020.1285. sourceDisputed

  The section “Procedures NOT to be applied in the Acute Phase” says that diaphragmatic and pursed-lip breathing are not recommended for patients with COVID-19 during the acute phase because treatments must not add to the work of breathing. The paper therefore makes the contrary point for the acute setting it addresses; it does not establish that breathing exercises are unhelpful in other settings. (LLM, conf=0.85)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured
• cites [16] Zhao H-M, Xie Y-X, Wang C. Recommendations for respiratory rehabilitation in adults with COVID-19. Chin Med J. 2020;133:1595–602. sourceSupported
• cites [17] Felten-Barentsz KM, van Oorsouw R, Klooster E, et al. Recommendations for hospital-based physical therapists managing patients with COVID-19. Phys Ther. 2020;100(9):1444–57. sourceSupported
• cites [18] Abdullahi A. Safety and efficacy of chest physiotherapy in patients with COVID-19: a critical review. Front Med. 2020;7:454. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Coronavirus disease 2019 (COVID-19) is a highly infectious respiratory tract disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

“Coronavirus disease 2019 (COVID-19) is a highly infectious respiratory tract disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1, 2].”

• cites [1] World Health Organization. COVID-19 clinical management: living guidance, 25 January 2021. World Health Organization (2021). https://apps.who.int/iris/handle/10665/338882. Accessed 1 Jan 2022.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [2] Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (Br Ed). 2020;395(10223):497–506. sourcePartly supported

  The Introduction identifies 2019-nCoV in lower respiratory tract samples from patients with pneumonia, supporting the claim that a novel coronavirus caused respiratory disease. The Discussion says evidence indicated human transmission but describes efficient human transmission as a concern, not an established finding; it does not support calling the disease “highly infectious.” The paper uses the earlier name 2019-nCoV rather than SARS-CoV-2. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

The most common clinical presentation of severe COVID-19 is viral pneumonia featuring fever, cough, dyspnoea, hypoxemia, and bilateral infiltrates on chest radiographs.

“Evidence shows that the most common clinical presentation of severe COVID-19 is viral pneumonia featuring fever, cough, dyspnoea, hypoxemia, and bilateral infiltrates on chest radiographs [2–4].”

• cites [2] Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (Br Ed). 2020;395(10223):497–506. sourcePartly supported

  The Results report pneumonia in all 41 patients, frequent fever and cough, dyspnoea in 12 of 13 ICU patients, and bilateral chest-radiograph involvement in all 13. The paper reports refractory hypoxaemia in only two patients and describes a small hospitalised cohort; it does not establish that the full combination is the most common presentation of severe COVID-19 generally. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [3] Ahmed T, Shah RJ, Rahim SEG, et al. Coronavirus Disease 2019 (COVID-19) complicated by acute respiratory distress syndrome: an internist’s perspective. Curēus. 2020;12(3):e7482. sourcePartly supported

  The Case presentation (page unavailable) describes one patient with cough, shortness of breath, low oxygen saturation, later fever and hypoxia, and bilateral infiltrates on a subsequent chest X-ray. The Discussion (page unavailable) identifies the case as severe COVID-19 and lists severe pneumonia among reported complications. Neither section establishes that this combination is the most common presentation of severe COVID-19; the patient initially denied fever, and the first X-ray showed a right-sided opacity. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [4] Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–20. sourcePartly supported

  The Results (Treatment and Complications; page not provided) report physician-diagnosed pneumonia in 99.4% of patients with severe disease. The Discussion identifies fever and cough as dominant symptoms and links compromised respiratory status to severity, but the available passages do not establish the full combination of dyspnoea, hypoxemia, and bilateral infiltrates on chest radiographs as the most common presentation. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

The sample of each group was large enough, and comparisons were not affected by the shape of the error distribution and no transformation was applied.

“The sample of each group was large enough, and comparisons were not affected by the shape of the error distribution and no transformation was applied [27].”

• cites [27] Rochon J, Gondan M, Kieser M. To test or not to test: Preliminary assessment of normality when comparing two independent samples. BMC Med Res Methodol. 2012;12:81. sourcePartly supported

  The Results (Strategy I; page unavailable) report that an unconditional two-sample t test maintained its nominal Type I error rate for the simulated normal, uniform, and exponential distributions. The paper does not establish that the citing study’s groups were large enough or that its comparisons were unaffected by their error distribution; it also does not address the citing authors’ decision not to transform their data. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Respiratory rehabilitation prevents the lungs from collapsing.

“It may improve oxygen exchange, prevents the lungs from collapsing, reduce psychological stress and the need for artificial ventilation [10–12].”

• cites [10] Bott J, Blumenthal S, Buxton M, et al. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax. 2009;64(Suppl 1):i1–52. sourceCould not verify

  The pulmonary rehabilitation section reports benefits for exercise tolerance, breathlessness and quality of life, but does not say rehabilitation prevents lung collapse. The spinal cord injury section describes collapse as a possible consequence of impaired ventilation and secretion clearance; it does not establish the claimed preventive effect. Searches for atelectasis and lung collapse found no passage making that link. (LLM, conf=0.72)

  Experimental — accuracy not yet measured
• cites [11] Gigliotti F, Romagnoli I, Scano G. Breathing retraining and exercise conditioning in patients with chronic obstructive pulmonary disease (COPD): a physiological approach. Respir Med. 2003;97(3):197–204. sourceNot checked — no full text of the source
• cites [12] Hopper SI, Murray SL, Ferrara LR, Singleton JK. Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review. JBI Database System Rev Implement Rep. 2019;17(9):1855–76. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Severe respiratory symptoms can cause respiratory failure (ARDS), which can lead to death unless promptly managed using ventilation at ICU.

“As mentioned before, severe respiratory symptoms can cause respiratory failure (ARDS), which can lead to death unless promptly managed using ventilation at ICU [2, 3, 6].”

• cites [2] Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (Br Ed). 2020;395(10223):497–506. sourcePartly supported

  The Discussion reports that severely ill patients developed ARDS and required ICU admission and oxygen therapy; the Results report mechanical ventilation in four patients and six deaths. The paper does not establish that prompt ICU ventilation prevents death or that death follows unless it is provided. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [3] Ahmed T, Shah RJ, Rahim SEG, et al. Coronavirus Disease 2019 (COVID-19) complicated by acute respiratory distress syndrome: an internist’s perspective. Curēus. 2020;12(3):e7482. sourcePartly supported

  The Case presentation and Discussion describe acute hypoxic respiratory failure progressing to moderate-to-severe ARDS, followed by intubation and mechanical ventilation in the ICU. The Discussion also reports that ARDS can have fatal outcomes. The paper does not establish that prompt ICU ventilation prevents death; the patient remained critically ill with a poor prognosis after ventilation. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [6] Yang L-L, Yang T. Pulmonary rehabilitation for patients with coronavirus disease 2019 (COVID-19). Chron Dis Transl Med. 2020;6(2):79–86. sourcePartly supported

  The section ‘Necessity of pulmonary rehabilitation for patients with COVID-19’ says severe cases can rapidly progress to ARDS. The ‘Pulmonary rehabilitation guidelines’ section says life-saving measures should take priority for unstable severe or critical cases, but our copy does not say that ARDS leads to death unless promptly treated with ventilation in an ICU. Page numbers are unavailable in our copy. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

A recent scoping review found that respiratory rehabilitation appears to be useful in COVID-19 survivors.

“The review found that respiratory rehabilitation appears to be useful in COVID-19 survivors, and respiratory rehabilitation starting already in a hospital may lead to improved overall respiratory function and reduced hospital stay.”

• cites [13] Siddiq MAB, Rathore FA, Clegg D, Rasker JJ. Pulmonary rehabilitation in COVID-19 patients: a scoping review of current practice and its application during the pandemic. Turk J Phys Med Rehabil. 2020;66(4):480–94. sourceSupported

Classified as probably not a substantial claim.

The authors of the scoping review concluded a paucity of high-quality research on respiratory rehabilitation in COVID-19.

“However, the authors concluded a paucity of high-quality research on this topic [13].”

• cites [13] Siddiq MAB, Rathore FA, Clegg D, Rasker JJ. Pulmonary rehabilitation in COVID-19 patients: a scoping review of current practice and its application during the pandemic. Turk J Phys Med Rehabil. 2020;66(4):480–94. sourceSupported

Classified as probably not a substantial claim. May combine two claims.

Respiratory rehabilitation starting already in a hospital may lead to improved overall respiratory function and reduced hospital stay.

“The review found that respiratory rehabilitation appears to be useful in COVID-19 survivors, and respiratory rehabilitation starting already in a hospital may lead to improved overall respiratory function and reduced hospital stay.”

• cites [13] Siddiq MAB, Rathore FA, Clegg D, Rasker JJ. Pulmonary rehabilitation in COVID-19 patients: a scoping review of current practice and its application during the pandemic. Turk J Phys Med Rehabil. 2020;66(4):480–94. sourcePartly supported

  The Discussion recommends starting pulmonary rehabilitation during a COVID-19 patient's inpatient stay and describes potential respiratory benefits. But its evidence for a shorter hospital stay comes from COPD patients, and it explicitly says the outcomes of these interventions in COVID-19 cases remain to be determined. Page numbers were not available in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Breathing exercise improves respiratory muscle function, ribcage flexibility, and gas exchange, and may decrease blood pressure, respiratory rate, and stress.

“The physiological rationale behind the progress might be that breathing exercise improves respiratory muscle function, ribcage flexibility, gas exchange, and may decrease blood pressure, respiratory rate, and stress [11, 12, 28, 29]; consequently, helping patients with COVID-19 to manage their respiratory symptoms.”

• cites [11] Gigliotti F, Romagnoli I, Scano G. Breathing retraining and exercise conditioning in patients with chronic obstructive pulmonary disease (COPD): a physiological approach. Respir Med. 2003;97(3):197–204. sourceNot checked — no full text of the source
• cites [12] Hopper SI, Murray SL, Ferrara LR, Singleton JK. Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review. JBI Database System Rev Implement Rep. 2019;17(9):1855–76. sourceNot checked — no full text of the source
• cites [28] McIlwaine M, Bradley J, Elborn JS, et al. Personalising airway clearance in chronic lung disease. Eur Respir Rev. 2017;26(143):160086. sourcePartly supported

  The ‘Active cycle of breathing techniques’ section (page unavailable) says thoracic expansion exercises and a breath hold improve ventilation distribution and alveolar gas mixing. That supports a respiratory-ventilation rationale, but it does not establish improved respiratory muscle function or ribcage flexibility, improved gas exchange itself, or reductions in blood pressure, respiratory rate, or stress. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [29] Elad D, Wolf M, Keck T. Air-conditioning in the human nasal cavity. Respir Physiol Neurobiol. 2008;163(1–3):121–7. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Respiratory rehabilitation should be considered when there are no signs of progressive deterioration and patients are hospitalised, as recommended by Chinese, the Netherlands, Italian, and UK rehabilitation professionals [6, 10, 15, 17, 33].

“Respiratory rehabilitation should be considered when there are no signs of progressive deterioration and patients are hospitalised, as recommendations by Chinese, the Netherlands, Italian, and UK rehabilitation professionals [6, 10, 15, 17, 33].”

• cites [6] Yang L-L, Yang T. Pulmonary rehabilitation for patients with coronavirus disease 2019 (COVID-19). Chron Dis Transl Med. 2020;6(2):79–86. sourceSupported
• cites [10] Bott J, Blumenthal S, Buxton M, et al. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax. 2009;64(Suppl 1):i1–52. sourcePartly supported

  The “Pulmonary rehabilitation peri-and postexacerbation” section recommends considering rehabilitation during an exacerbation for patients with COPD and describes inpatient rehabilitation during admission. It does not give absence of progressive deterioration as a criterion or extend that recommendation to hospitalised patients generally. The passages provided do not give a page number. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [15] Lazzeri M, Lanza A, Bellini R, et al. Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Arch Chest Dis. 2020. https://doi.org/10.4081/monaldi.2020.1285. sourcePartly supported

  In the section on preventing physical disability (page unavailable), the Italian position paper recommends early mobilization once the patient's condition is clinically stable; its Conclusions describe physiotherapy for hospitalized patients with severe COVID-19. This supports considering mobilization during hospitalization when the patient is stable, but it does not expressly recommend respiratory rehabilitation as a whole under that condition. (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites [17] Felten-Barentsz KM, van Oorsouw R, Klooster E, et al. Recommendations for hospital-based physical therapists managing patients with COVID-19. Phys Ther. 2020;100(9):1444–57. sourcePartly supported

  The Treatment recommendations (Section 2: Patient Is Severely Ill and Admitted to the COVID Ward; page unavailable) recommend respiratory support for hospitalized patients with COVID-19, and the Abstract identifies the paper as Dutch guidance. The passages do not make an absence of progressive deterioration a condition for considering respiratory rehabilitation. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [33] Wang TJ, Chau B, Lui M, et al. Physical medicine and rehabilitation and pulmonary rehabilitation for COVID-19. Am J Phys Med Rehabil. 2020;99(9):769–74. sourcePartly supported

  The Introduction (page unavailable) supports considering pulmonary rehabilitation for hospitalized patients, with safety screening that excludes patients with substantial chest-image progression and other signs of instability. It does not say that an absence of progressive deterioration is sufficient on its own, or identify this recommendation as one made collectively by Chinese, Dutch, Italian, and UK rehabilitation professionals. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

• AssumptionRests on an assumption: There is a high respiratory impairment burden following the acute phase of COVID-19.

May combine two claims.

Abdominal chest imaging and severe impairment to pulmonary diffusion capacities was reported in COVID-19 patients recovered from severe illness [32].

“Abdominal chest imaging, and severe impairment to pulmonary diffusion capacities was reported in COVID-19 patients recovered from severe illness [32].”

• cites [32] Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220–32. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

It has previously been recommended that breathing exercises be stopped for chest pain, palpations, and dizziness and be stopped if SpO2 does not recover even with rest and oxygen supplementation [33].

“It has previously been recommended that breathing exercises be stopped for chest pain, palpations, and dizziness and be stopped if SpO2 does not recover even with rest and oxygen supplementation [33].”

• cites [33] Wang TJ, Chau B, Lui M, et al. Physical medicine and rehabilitation and pulmonary rehabilitation for COVID-19. Am J Phys Med Rehabil. 2020;99(9):769–74. sourcePartly supported

  The Introduction recommends stopping rehabilitation exercises for chest pain, palpitations, or dizziness. It also recommends stopping pulmonary rehabilitation or breathing exercises when SpO2 does not recover with rest and oxygen supplementation, but specifies an additional condition: the patient cannot maintain a Borg dyspnea score below 4. The claim omits that condition. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Patients can be in all suitable positions including prone, side-lying, upright, supine, and guided by the location of consolidations seen on imaging or found on examination [31].

“However, the patients can be in all suitable positions including prone, side-lying, upright, supine, and guided by the location of consolidations seen on imaging or found on examination [31].”

• cites [31] Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, et al. Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis. Travel Med Infect Dis. 2020;34:101623. sourceCould not verify

  The Results section, “Imaging, complications, and outcomes” (page unavailable), reports chest X-ray findings but does not discuss patient positioning. Searches for prone, side-lying, upright, and supine positions, and for positioning guided by consolidation location or examination, found no supporting passage in our copy. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim. May combine two claims.

In patients with COVID-19, low blood oxygen levels are associated with rapid deterioration to acute respiratory distress or failure, leading to death unless it is managed immediately [2-4].

“In patients with COVID-19, low blood oxygen levels are associated with rapid deterioration to acute respiratory distress or failure, leading to death unless it is managed immediately [2–4].”

• cites [2] Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (Br Ed). 2020;395(10223):497–506. sourcePartly supported

  The Discussion (page not provided) says severe patients developed ARDS, sometimes within two days of admission, and six of 41 patients died. The Results also report refractory hypoxaemia in two patients who received salvage therapy. The paper does not establish that low oxygen levels predict rapid deterioration or that death follows unless they are managed immediately. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [3] Ahmed T, Shah RJ, Rahim SEG, et al. Coronavirus Disease 2019 (COVID-19) complicated by acute respiratory distress syndrome: an internist’s perspective. Curēus. 2020;12(3):e7482. sourcePartly supported

  The Case presentation and Conclusions describe one patient whose hypoxia worsened rapidly and who developed respiratory failure and moderate-to-severe ARDS within 48 hours. The paper does not establish this as a general association in patients with COVID-19 or show that death follows unless the condition is managed immediately; the patient remained critically ill in the ICU at the time of reporting. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [4] Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–20. sourcePartly supported

  The Discussion links compromised respiratory status on admission to worse outcomes, and the Results report ARDS and deaths among patients with COVID-19. The paper does not establish that low blood oxygen causes rapid progression to respiratory failure or that death follows unless it is managed immediately. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

A forced expiratory technique like huffing and coughing increases the linear velocity of the expiratory airflow and propels secretions, which helps in airway clearance [28].

“A forced expiratory technique like huffing and coughing increases the linear velocity of the expiratory airflow and propels secretions, which help in airways clearance [28].”

• cites [28] McIlwaine M, Bradley J, Elborn JS, et al. Personalising airway clearance in chronic lung disease. Eur Respir Rev. 2017;26(143):160086. sourceSupported

May combine two claims.

Suitable positioning may enhance ventilation, perfusion, oxygenation, and mobilization of tracheobronchial secretions via gravitational effects [23, 30].

“Suitable positioning may be used to enhance ventilation, perfusion, oxygenation, and mobilization of tracheobronchial secretions via gravitational effects [23, 30].”

• cites [23] Schifino G, de Grauw AJ, Daniele F, et al. Effects of prone and lateral position in non-intubated patients with 2019 Novel Coronavirus (COVID-19) pneumonia. Pulmonology. 2021;27(2):167–71. sourcePartly supported

  In the paper’s main text (page unavailable), prone and lateral positioning are associated with improved oxygenation and breathing pattern, and the authors describe gravity-related changes in ventilation–perfusion matching. The paper does not address mobilization of tracheobronchial secretions, so it supports only part of the cited sentence. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [30] Cullen DL, Rodak B. Clinical utility of measures of breathlessness. Respir Care. 2002;47(9):986–93. sourceNot checked — no full text of the source

May combine two claims.

The intervention group included 79 patients (69.6% men, mean age 50.1 ± 10.5 years), and the control group included 58 patients (62.1% men, mean age 51.5 ± 10.4 years).

“The intervention group included 79 patients (69.6% men, mean age 50.1 ± 10.5 years), and the control group included 58 patients (62.1% men, mean age 51.5 ± 10.4 years).”

May combine two claims.

At baseline, there were no significant differences (P > 0.05) in mean SpO2, need for oxygen, respiratory rate, or heart rate between the intervention and control groups.

“At the baseline, no significant differences were found (P > 0.05) in the mean values of SpO2, the need for oxygen, respiratory rate, and heart rate between the intervention and the control group (Table 2).”

May combine two claims.

The COVID-19 patients included in the intervention group were sufficiently stable during the study period, and only three patients needed admission to the ICU after the intervention started.

“It should be noted that the COVID-19 patients included in the intervention group in our study were sufficiently stable during the study period, and only three patients needed to admit to the ICU after the intervention started.”

Classified as probably not a substantial claim. May combine two claims.

Both groups received a standard protocol for data collection, such as the same types of equipment, the same time of the day, and ensured comparability among the measures in the respective hospital.

“Both groups (intervention and control) received a standard protocol for data collection, such as the same types of equipment, the same time of the day, and ensure comparability among the measures in the respective hospital.”

May combine two claims.

The sociodemographic and hematological data, and presence of comorbidity did not differ statistically between the intervention and control groups (P > 0.05), except total White Blood Cell count was higher in the intervention group compared to the control group (P = 0.04).

“The sociodemographic- and hematological data, and presence of comorbidity did not differ statistically between the intervention and the control groups (P > 0.05), except for the total White Blood Cell (WBC) count that was found higher in the intervention group, compared to the control group (P = 0.04).”

Probably not a substantial claim: may not pass S3 (load-bearing).

A priori power analysis for a repeated-measures analysis of variance with two repeated-measures showed that a total of 108 participants would be required to get a statistical power (1 − β err prob) of 80%.

“A priori power analysis for a repeated-measures analysis of variance with two repeated-measures showed that a total of 108 participants would require to get a statistical power (1 − β err prob) of 80%.”

Classified as probably not a substantial claim. May combine two claims.

A total of 79 persons in the intervention and 58 persons in the control group were analysed at 4-day follow-up, and 64 persons in the intervention and 50 persons in the control group were analysed at 7-day follow-up.

“A total of 79 persons in the intervention and 58 persons in the control group were analysed at 4-day of follow-up, and 64 persons in the intervention and 50 persons in the control group were analysed at 7-day of follow-up (Fig. 1).”

Probably not a substantial claim: may not pass S3 (load-bearing).

A physiotherapist supervised each breathing exercise session.

“A physiotherapist supervised each breathing exercise session”

Classified as probably not a substantial claim.

Respiratory rehabilitation improves the physical and psychological symptoms of lung diseases such as chronic obstructive pulmonary disease (COPD).

“Respiratory rehabilitation improves the physical and psychological symptoms of lung diseases such as chronic obstructive pulmonary disease (COPD) [11].”

• cites [11] Gigliotti F, Romagnoli I, Scano G. Breathing retraining and exercise conditioning in patients with chronic obstructive pulmonary disease (COPD): a physiological approach. Respir Med. 2003;97(3):197–204. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Among all sessions, at least three sessions were delivered by direct supervision of the physiotherapist; the rest were delivered with the assistance of a trained nurse or nursing assistant and were recorded in an activity log.

“Among all sessions, at least three sessions were delivered by direct supervision of the Physiotherapist. The rest of the sessions were delivered with the assistance of a trained nurse or nursing assistant and were recorded in an activity log.”

Probably not a substantial claim: may not pass S2 (checkable).

These results should be considered preliminary until they are replicated in larger samples in different settings.

“These results should be considered preliminary until they are replicated in larger samples in different settings.”

Classified as probably not a substantial claim. May combine two claims.

For the present study, outcomes were measured when a patient was in a complete resting position at around 10.00 am, at baseline, and 4 days and 7 days after baseline, and measurements were taken at least 30 min after any breathing exercise session for the intervention group.

“For the present study, we measured the outcomes when a patient was in a complete resting position at around 10.00 am, at baseline, and 4 days and 7 days after the baseline assessment for the intervention and the control group. However, the measurements were taken at least 30 min after any breathing exercise session for the intervention group.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The elected hospital for intervention consisted of a well-trained physiotherapists' team in the breathing exercise intervention.

“The elected hospital for intervention consisted of a well-trained physiotherapists' team in the breathing exercise intervention.”

Classified as probably not a substantial claim.

The selected hospitals had equally trained qualified health care workers (e.g., nurses, physicians, or physiotherapists) for patients' assessment and data collection.

“We selected all these hospitals based on the criteria that they have equally trained qualified health care workers (e.g., nurses, physicians, or physiotherapists) for patients' assessment and data collection.”

Probably not a substantial claim: may not pass S2 (checkable).

These results should be considered preliminary until they are replicated in larger samples in various settings.

“These results should be considered preliminary until they are replicated in larger samples in various settings.”

May combine two claims.

A systematic review of randomized controlled trials and two quasi-experimental studies in adults suggests that diaphragmatic breathing may decrease blood pressure, respiratory rate, and psychological stress [12].

“A systematic review of randomized controlled trials and two quasi-experimental studies in adults suggests that diaphragmatic breathing may decrease blood pressure, respiratory rate, and psychological stress [12].”

• cites [12] Hopper SI, Murray SL, Ferrara LR, Singleton JK. Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review. JBI Database System Rev Implement Rep. 2019;17(9):1855–76. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Inspiration through the nose facilitates recruitment of the diaphragm and improves humidification [29].

“Inspiration through the nose should be encouraged to facilitate the recruitment of the diaphragm and improve humidification [29].”

• cites [29] Elad D, Wolf M, Keck T. Air-conditioning in the human nasal cavity. Respir Physiol Neurobiol. 2008;163(1–3):121–7. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Study participants were recruited from four tertiary hospitals in Bangladesh; the intervention group from one hospital, and the control group from the other three hospitals. Therefore, resource availability might differ between hospitals.

“Study participants were recruited from four tertiary hospitals from Bangladesh; the intervention group from one hospital, and the control group from the other three hospitals. Therefore, resource availability might differ between hospitals.”

May combine two claims.

Patients with COVID-19 were not excluded based on pre-specified comorbidities (e.g., COPD), so the findings apply to similar populations.

“Further patients with COVID-19 were not excluded based on pre-specified comorbidities (e.g., COPD). Thus, our findings apply to similar populations.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Typically, a non-productive cough is associated with COVID-19; productive coughing may appear at a later stage [19].

“Typically, a non-productive cough is associated with COVID-19; productive coughing may appear at a later stage [19].”

• cites [19] Sun P, Lu X, Xu C, et al. Understanding of COVID-19 based on current evidence. J Med Virol. 2020;92(6):548–51. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

No specific information about the number of interventions was collected between the 5-day and 7-day follow-up, as the intervention was varied or reduced based on patients' needs during this follow-up period.

“Another limitation of our study is that no specific information about the number of interventions was collected between the 5-day and 7-day of follow-up, as the intervention was varied or reduced based on patients' needs during this follow-up period.”

May combine two claims.

Breathing exercises, as part of respiratory rehabilitation, improved respiratory parameters (SpO2, respiratory rate, heart rate, and need for oxygen) in patients hospitalised with COVID-19, with greater improvement in the intervention group than in the control group.

“One of the key findings of the present study was that SpO2, respiratory rate, and heart rate improved in patients with COVID-19 who received breathing exercise while reducing their need for oxygen therapy.”

• Also stated in: § Discussion · boosted

  “The results supported our original hypothesis that respiratory parameters would improve in both intervention and control groups, with the intervention group demonstrating more significant improvements compared to the control group.”

• Also stated in: § Conclusions · plain

  “Breathing exercise as a part of respiratory rehabilitation improved respiratory parameters in patients hospitalised with COVID-19.”

May combine two claims.

Standardised care was provided to all patients according to the National Guidelines on Clinical Management of COVID-19 [22], and a standard protocol for data collection was followed to ensure comparability among measures collected in different hospitals.

“However, the standardised care was provided to all patients according to the National Guidelines on Clinical Management of COVID-19 [22], and we followed a standard protocol for data collection (e.g., same instrument, same time of the day, same order) to ensure comparability among the measures collected in different hospitals.”

• cites [22] National Guidelines on Clinical Management of Coronavirus Disease 2019 (Covid-19). Disease Control Division Directorate General of Health Services Ministry of Health & Family Welfare Government of the People's Republic of Bangladesh, 2020.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The sample was representative of both sexes and sociodemographic background, with broad age groups (18-70 years).

“Another strength is the representative sample size from both sexes and sociodemographic background (e.g., educational level, employment), with broad age groups (18–70 years).”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

Health care systems are overwhelmed in many countries; respiratory rehabilitation provides some respite.

“Health care systems are overwhelmed in many countries; respiratory rehabilitation thus provides some respite.”

• AssumptionRests on an assumption: Respiratory rehabilitation is non-invasive, safe, easy to implement, and cost-effective.
• AssumptionRests on an assumption: Health care systems are overwhelmed in many countries.