Data extraction.

Introduction
Adult and pediatric patients admitted to intensive care units (ICUs) requiring invasive ventilatory support, sedation, and muscle blockade may present neuromusculoskeletal deterioration. Different physical rehabilitation interventions have been studied to evaluate their effectiveness in improving critically ill patients’ outcomes. Given that many published systematic reviews (SRs) aims to determine the effectiveness of different types of physical rehabilitation interventions, it is necessary to group them systematically and assess the methodological quality of SRs to help clinicians make better evidence-based decisions. This overview of SRs (OoSRs) aims to map the existing evidence and to determine the effectiveness of physical rehabilitation interventions to improve neuromusculoskeletal function and other clinical outcomes in adult and pediatric critically ill patients.
Methods
An OoSRs of randomized and non-randomized clinical trials involving critically ill adult and pediatric patients receiving physical rehabilitation intervention will be conducted. A sensitive search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos, and other search resources will be conducted. Two independent reviewers will conduct study selection, data extraction, and methodological quality assessment. Discrepancies will be resolved by consensus or a third reviewer. The degree of overlap of studies will be calculated using the corrected covered area. The methodological quality of the SRs will be measured using the AMSTAR-2 tool. The GRADE framework will report the certainty of evidence by selecting the "best" SR for each physical rehabilitation intervention and outcome.
Discussion
The findings of this overview are expected to determine the effectiveness and safety of physical rehabilitation interventions to improve neuromusculoskeletal function in adult and pediatric critically ill patients based on a wide selection of the best available evidence and to determine the knowledge gaps in this topic by mapping and assessing the methodological quality of published SRs.
Registration number
CRD42023389672.

引言
收住重症监护病房（Intensive Care Unit, ICU）且需接受有创通气支持、镇静及肌肉阻滞的成人与儿科患者，可能出现神经肌肉骨骼功能恶化。已有多项研究针对各类物理康复干预手段开展评估，以考察其改善重症患者预后的效果。鉴于已有大量已发表的系统评价（Systematic Review, SR）旨在明确不同类型物理康复干预的有效性，因此有必要对这类系统评价进行系统归类，并评估其方法学质量，以助力临床医师做出更优质的循证决策。本系统评价概述（Overview of Systematic Reviews, OoSR）旨在梳理现有证据，明确物理康复干预对成人与儿科重症患者神经肌肉骨骼功能及其他临床结局的改善效果。

方法
本研究将针对纳入接受物理康复干预的成人及儿科重症患者的随机与非随机临床试验，开展系统评价概述分析。将在MEDLINE（Ovid平台）、Embase（Ovid平台）、CINAHL（EBSCOhost平台）、Cochrane图书馆、Epistemonikos数据库及其他检索资源中开展高灵敏度文献检索。由2名独立评审员独立完成文献筛选、数据提取及方法学质量评估；评审间的分歧将通过协商一致解决，或引入第三名评审员进行裁决。将采用校正覆盖面积法计算研究间的重叠程度。系统评价的方法学质量将采用AMSTAR-2工具进行评估。将基于GRADE分级框架，为每种物理康复干预及结局指标遴选最优系统评价，以此报告证据的确定性等级。

讨论
本概述的研究结果有望基于精选的最优现有证据，明确物理康复干预对成人及儿科重症患者神经肌肉骨骼功能的改善效果与安全性；同时通过梳理并评估已发表系统评价的方法学质量，明确该领域尚存的研究空白。

登记号
CRD42023389672.