key: cord-0903082-k04ipc4f authors: Wang, Jilin; Cui, Yanru; Liu, Shuang; Zhou, Jiangxue; Sun, Yingxia title: Assessment of the effects of Liuzijue Qigong on the lung function of COVID-19 patients during disease recovery: A protocol for systematic review and meta-analysis date: 2021-08-06 journal: Medicine (Baltimore) DOI: 10.1097/md.0000000000026866 sha: 9f12bc0800cf0b943a061752e557be86f2a4ca9a doc_id: 903082 cord_uid: k04ipc4f BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak began in late 2019 and spread rapidly throughout China and then the rest of the world. COVID-19 is a serious respiratory disease and many patients’ exhibit varying levels of persistent parenchymal lung damage. However, there is currently a lack of effective rehabilitation treatments for COVID-19 patients with lung damage. Several clinical trials have shown that Liuzijue Qigong (LQG) can enhance the strength of respiratory muscles and overall quality of life. In this study, a meta-analysis approach was used to assess the effects of LQG on the lung function of COVID-19 patients during disease recovery. METHODS: Eight databases will be explored for relevant investigations including China National Knowledge Infrastructure, Wanfang, VIP, China Biology Medicine, EMBASE, PubMed, Web of Science, and the Cochrane Library. All databases will be explored for articles published from inception through July 2021. Data will be extracted independently by 2 researchers according to the eligibility criteria. Finally, RevMan 5.3.0 will be implemented for statistical analyses. RESULTS: The results of this study will show the effects of LQG on the lung function of COVID-19 patients during disease recovery and will be submitted to a peer-reviewed journal for publication. CONCLUSIONS: This study will provide reliable evidence based on the effects of LQG on the lung function of COVID-19 patients during disease recovery. TRIAL REGISTRATION NUMBER: CRD42021268102 The coronavirus disease 2019 (COVID-19) outbreak began in late 2019, and spread rapidly first through China and then throughout the globe, [1, 2] with the World Health Organization having stated a pandemic in March of 2020. [3] COVID-19 patients experience a range of symptoms including cough, fever, lethargy, dyspnea, sputum production, and non-respiratory symptoms including myalgia, diarrhea, and headache. [4, 5] As of July 15, 2021, over 189,019,833 COVID-19 cases and 4,068,447 deaths have been recorded worldwide. As a serious respiratory disease, many COVID-19 patients exhibit varying levels of persistent parenchymal lung damage. [6] It is thus vital that effort be made to identify safe and effective treatments that can aid in rehabilitative care for recovering COVID-19 patients. The Chinese government has strongly advocated the integrative application of both Western medicines and traditional Chinese medicine (TCM) within the context of COVID-19 management in light of insights gained during the previous severe acute respiratory syndrome (SARS) outbreak. [7] Liuzijue Qigong (LQG) is a traditional method of Chinese health physical activity that has long been practiced owing to its purported benefits to human health. LQG is performed through coordinated movement and exhalation while creating 6 specific sounds (xu, he, hu, JW and YC contributed equally to this work. An ethical statement is not required for this study as no identifiable individuals were included in the analysis. si, chui, and xi). Many clinical trials have demonstrated the ability of LQG to ameliorate the standards of living and the strength of respiratory muscles. [8] [9] [10] No systemic analyses of the impact of practicing LQG on pulmonary functions in cases that have been recovered from COVID-19 have been conducted to date, however. We, therefore, endeavor to execute a systematic review and meta-analysis of this topic to generate high-quality research evidence that can guide future clinical efforts to guide patient recovery. The registration of the current protocol has been performed via using the PROSPERO, registration number CRD42021268102, and will be executed in strict accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols instructions. [11] 2.2. Eligibility criteria 2.2.1. Research types. All randomized controlled trials reported in English or Chinese will be eligible for inclusion. Eligible studies will be those evaluating patients in the recovery phase of a diagnosed COVID-19 infection without any age, gender, or ethnicity restrictions. Control patients will be those that have undergone routine treatment, whereas experimental group patients will be those that have undergone LQG therapy in addition to routine treatment. , and China Biology Medicine) and 4 English databanks (EMBASE, PubMed, Web of Science, and Cochrane Library). All databases will be explored for articles published from inception through July 2021 using a combination of relevant search terms of MeSH terms. The PubMed search strategy is outlined in Table 1 , and an identical approach will be employed for other databanks. 2.3.2. Searching other resources. Investigators will also seek to identify other relevant resources including unpublished trials in the Chinese Clinical Trial Registry and the US National Institutes of Health Ongoing Trials Register. Identified studies of potential relevance will initially be imported into Endnote X9, after which 2 investigators will independently screen the eligibility of these studies for inclusion in the final meta-analysis. Discords will be figured out by negotiation with a third researcher. Two researchers will then independently extract the following information from included investigations: author names, publication year, title, country, average age, gender, study design, participants, total case number, intervention measures, comparisons, outcomes, and other relevant details. When necessary information is unavailable, efforts will be made to contact the original authors. The study screening process is outlined in Figure 1 . The Cochrane Risk of Bias Risk Assessment Tool will be independently employed by 2 researchers to evaluate study quality. The risk of bias will be assessed based on the following: random method, assignment concealment, approach to subject blinding, approach to result evaluation blinding, selective reporting, data integrity, and other biases. Each of these parameters will be assigned a high, low, or uncertain bias risk. Disagreements will be figured out by negotiation with a third investigator. RevMan 5.3.0 will be implemented for statistical analyses. Heterogeneity among investigations will be detected using chisquared tests. Fixed-effects models will be used to analyze data when no considerable heterogeneity is discerned (P ≥ .1 and I 2 50%), while random-effects models will otherwise be applied. Dichotomous data will be studied applying odds ratios with confidence intervals of around 95%, while continuous variables will be represented utilizing mean difference values and 95% confidence intervals. When appropriate, sensitivity analyses will be accomplished by iteratively excluding individual studies from pooled analyses to assess result stability. When no qualitative changes in these outcomes are observed, the results will be considered stable. To evaluate the potential for publication bias, the plots of the funnel will be drawn when sufficient studies were available (n ≥ 10). In addition, the risk of publication bias will be appraised by utilizing Egger assessment. The quality of outcome-related evidence will be appraised by implementing the Grading of Recommendations Assessment, Development, and Evaluation method, and will be classified as either high, medium, low, or negligible. [12] 3. Discussion Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, is almost tied to the SARS and Middle East respiratory syndrome coronavirus viruses responsible for prior outbreaks of severe pulmonary disease. [13] SARS-CoV-2 infection can result in severe pneumonia-like symptoms in affected individuals, [14] and a subset of COVID-19 survivors exhibit persistent physiological complications and radiological defects including abnormal lung functionality and restrictive ventilatory defects. [15, 16] Prior research has demonstrated that exercise training can facilitate pulmonary rehabilitation, improving symptoms such as dyspnea and the overall health of practitioners while reducing the need for other healthcare interventions. Beneficial outcomes have been ascribed to the use of TCM herbal remedies, Qigong exercises, and dietary advice formulated in accordance with TCM theories. [17, 18] Several clinical trials have generated evidence that LQG can enhance the strength of respiratory muscles and overall quality of life. [8] [9] [10] 19] At present, Shanghai University of Traditional Chinese Medicine recommends traditional LQG training as an approach to enhancing the restoration of normal pulmonary function in individuals recovering from COVID-19. [20] To date, however, no meta-analyses have explored the influence of LQG on pulmonary outcomes in recovering COVID-19 patients. We will therefore conduct the meta-analysis proposed in this protocol to provide evidence-based guidance for aiding COVID-19 patient pulmonary rehabilitation. Formal analysis: Jilin Wang Writing -review & editing Current status of epidemiology, diagnosis, therapeutics, and vaccines for novel coronavirus disease 2019 (COVID-19) Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: a retrospective cohort study World Health Organization. World Health Organization; Geneva: 2020. WHO Director-General's Opening Remarks at the Media Briefing on COVID-19-11 Recent developments on therapeutic and diagnostic approaches for COVID-19 Detection technologies and recent developments in the diagnosis of COVID-19 infection Respiratory rehabilitation for post-COVID19 patients in spa centers: first steps from theory to practice Traditional chinese medicine in the treatment of patients infected with 2019-new coronavirus (SARS-CoV-2): a review and perspective Effectiveness of water-based Liuzijue exercise on respiratory muscle strength and peripheral skeletal muscle function in patients with COPD Efficacy of Liuzijue Qigong in individuals with chronic obstructive pulmonary disease in remission Liuzijue is a promising exercise option for rehabilitating discharged COVID-19 patients Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation Advance in the GRADE approach to rate the quality of evidence from a network meta-analysis Emerging novel coronavirus (2019-nCoV)-current scenario, evolutionary perspective based on genome analysis and recent developments Origin, transmission, diagnosis and management of coronavirus disease Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery Abnormal pulmonary function in COVID-19 patients at time of hospital discharge Role of exercise in testing and in therapy of COPD Exercise assessment and training in pulmonary rehabilitation for patients with COPD Comparative effect of Liuzijue Qigong and conventional respiratory training on trunk control ability and respiratory muscle function in patients at an early recovery stage from stroke: a randomized controlled trial Guidelines and suggestions of integrated traditional Chinese and western medicine rehabilitation training for COVID-19 patients' functional recovery The authors have no conflicts of interests to disclose.Data sharing not applicable to this article as no datasets were generated or analyzed during the present study.