S YS T E M AT I C R E V I E W P R O T O C O L

Palliative rehabilitation interventions in palliative care:

a scoping review protocol
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Vitor Parola 1,2,3  Adriana Coelho 2,3  Hugo Neves 2,3  Daniela Cardoso 2,3  Maria Almeida 2  Arménio Cruz 2 
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João Apóstolo 2,3

1
University Fernando Pessoa, Faculty of Health Sciences, Porto, Portugal, 2Health Sciences Research Unit: Nursing, Nursing School of Coimbra,
Coimbra, Portugal, and 3Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal

ABSTRACT

Objective: The objective of this scoping review is to examine and map interventions of palliative rehabilitation that
are implemented and evaluated in palliative care.
Introduction: Palliative rehabilitation is defined as the process of helping individuals with a progressive, often
advanced or incurable disease reach their physical, psychological, and social potential consistent with physiological
and environmental limitations and life preferences. Rehabilitation may prolong functional independence and
improve quality of life. Information on palliative rehabilitation interventions, their characteristics, contexts, and
population is dispersed throughout the literature, hence the need for a scoping review.
Inclusion criteria: This scoping review will consider all studies that focus on qualified health care professionals
working in palliative care who are caring for patients 18 years of age or older, and studies that focus on the concepts
of palliative rehabilitation interventions. This scoping review will consider all palliative rehabilitation interventions
implemented and evaluated in the context of palliative care.
Methods: The search strategy aims to find published and unpublished studies. The databases to be searched will
include CINAHL Complete, PubMed, Scopus, SciELO, Cochrane Central Register of Controlled Trials, and PEDro. The
search for unpublished studies will include DART-Europe, OpenGrey, and RCAAP. Studies published in English,
Spanish, and Portuguese carried out from 2009 onward will be considered for inclusion. Retrieved papers will be
screened for inclusion by two reviewers. Data will be extracted and presented in tabular form and a narrative
summary that aligns with the review’s objective. Any disagreements that arise between the reviewers will be resolved
through discussion or with a third reviewer.
Keywords end of life care; palliative care; rehabilitation; rehabilitation nursing; scoping review
JBI Evid Synth 2020; 18(11):2349–2356.

Introduction through the prevention and relief of suffering by

ife expectancy is gradually increasing as a result
L of advances in health care. Subsequently, the
number of persons living with chronic degenerative
and disabling disease has increased as a result of
advances in health care.1 This factor has contributed
to an increasing need for palliative care. According
to the World Health Organization’s 2002 definition,
palliative care is ‘‘an approach that improves the
quality of life of patients and their families facing the
problems associated with life-threatening illness,
Correspondence: Vitor Parola, vparola@ufp.edu.pt
The authors declare no conflict of interest.
DOI: 10.11124/JBIES-20-00024
means of early identification and impeccable assess-
ment and treatment of pain and other problems,
physical, psychosocial and spiritual.’’2(p.84) Since
the publication of this definition, the approach to
palliative care has changed from being a service in
the last days of life to being a holistic approach to
managing symptoms associated with progressive
disease and disability, and according to the needs
of patients and families.3,4
Palliative care is an interdisciplinary and interpro-
fessional approach to care that aims to relieve physi-
cal, psychosocial, and spiritual symptoms in order to
maintain the highest level of function. Rehabilitation
professionals are an integral part of this team.5,6
Both palliative care and rehabilitation share essential

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 SYSTEMATIC REVIEW PROTOCOL
characteristics in that they are symptom-oriented
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approaches that focus on function and comfort
within a holistic framework.7 The goal is to promote
independence in self-care activities, better symptom-
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atic control, and stabilization of functional decline in
line with individual life preferences. Ongoing assess-
ment of patient response indicating improvement,
stabilization, or deterioration is conducted, and reg-
imens are modified as appropriate.8-10 Rehabilita-
tion may ‘‘improve quality of life by palliating
function, mobility, activities of daily living, pain
relief, endurance, and the psyche of a patient while
helping to maintain as much independence as pos-
sible.’’11(p.34) Many palliative care patients are
unduly restricted in performing according to their
functional capacity5,6,12; however, it is only possible
to reach the patient’s maximum potential in the
presence of symptomatic control and when provided
with the proper incentive.5,6,12
Regardless of substantial advances in understand-
ing the benefits of early integration of palliative care
with disease management, many people living with a
chronic, life-threatening illness either do not have any
palliative care service or receive services just in the last
phase of their illness.1,13,14 Approximately 50% of
admissions in several palliative care units end with the
patient returning home or to families.5 Palliative
rehabilitation enhances the likelihood of the patient
returning home with the highest possible functional
independence, and offers a support system to help
patients live as creatively and actively as possible until
death. Unfortunately, not all palliative care units
adopt a rehabilitative approach to patient care.5,8,11
Patients have described rehabilitation as bringing
a sensation of relief, well-being, and confidence.
These time-limited improvements in specific ranges
can potentially enhance functional independence
and the ability to continue being active for as long
as possible, contributing to a higher quality of
life.15,16 Other studies with cancer patients reinforce
the importance of palliative rehabilitation with char-
acteristics such as pain, mobility, mood, cognitive
function, and quality of life.17,18 In the case of
chronic heart failure, chronic obstructive pulmonary
disease, and neurologic illnesses, there is evidence
that palliative rehabilitation has an impact in quality
of life, mood, the ability to exercise, fatigue, and
dyspnea.19,20 However, information on imple-
mented and evaluated interventions, their character-
istics, contexts of application, and population is
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V. Parola et al.
dispersed in the literature, which impedes the con-
struction of precise questions on the effectiveness of
those interventions and, consequently, the conduct
of a systematic review. It is acknowledged that
different interventions were implemented in differ-
ent contexts; however, a summary of palliative reha-
bilitation interventions implemented in the context
of palliative care does not exist. The literature does
not clarify the characteristics of the different pallia-
tive rehabilitation interventions programs.
Therefore, the objective of this review will be to
clarify the characteristics, contexts, and application
of palliative care interventions. Having a map of the
nature of the evidence in this area is needed to guide
development of precise questions on effectiveness or
meaning. This scoping review intends to respond to
these questions.
This scoping review will utilize JBI methodology
for the conduct of scoping reviews.21,22 According to
JBI, ‘‘scoping reviews undertaken with the objective
of providing a map of the range of the available
evidence can be undertaken as a preliminary exercise
prior to the conduct of a systematic review.’’21(p.6)
Therefore, this mapping of rehabilitation interven-
tions will explore relevant information to help
develop knowledge, identify possible gaps, and
inform systematic reviews.
This scoping review is part of a research project
that may lead to a systematic review focusing on the
best evidence on the effects of palliative rehabilita-
tion interventions. In addition, this mapping will
help inform the scientific community of the available
rehabilitation interventions for patients in palliative
care.
An initial search of the JBI Database of Systematic
Reviews and Implementation Reports, the Cochrane
Library, MEDLINE, and CINAHL revealed no scop-
ing review (published or in progress) on this topic.
Therefore, it is important to examine and map inter-
ventions of palliative rehabilitation that are imple-
mented and evaluated in palliative care.
Review questions
i) What palliative rehabilitation interventions
have been implemented and evaluated?
ii) In which domains (physical, cognitive, and
emotional) have palliative rehabilitation inter-
ventions been implemented?
iii) What are the characteristics (duration, dose,
and frequency) of these interventions?
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iv) Which health care professionals (e.g., nurses,
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physicians, physiotherapists) implement pallia-
tive care rehabilitation interventions?
v) In which populations (oncology and non-oncol-
1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 01/14/2024
ogy patients) are the palliative rehabilitation
interventions implemented and evaluated?
Inclusion criteria
Participants
This scoping review will consider all studies that
include patients 18 years of age or older.
Concept
This review will include studies that focus on palliative
rehabilitation interventions provided by a qualified
health care professional, including, but not limited to,
physicians, registered nurses, physiotherapists, psychol-
ogists, social workers, and occupational therapists.
These interventions may include, but will not be
limited to, respiratory kinesiotherapy, cardiac rehabil-
itation, physical rehabilitation, and gait reeducation.
Context
This scoping review will consider palliative rehabili-
tation interventions implemented and evaluated in
the context of specialist palliative care, more specifi-
cally, palliative care units, specialized palliative
home care, or hospices.
Types of sources
This scoping review will consider quantitative stud-
ies, qualitative studies, and systematic reviews.
Quantitative designs include any experimental
study designs (e.g., randomized controlled trials,
non-randomized controlled trials, or other quasi-
experimental studies, including before and after stud-
ies), and observational designs (e.g., descriptive studies,
cohort studies, cross-sectional studies, case studies, and
case series studies). Qualitative designs include any
studies that focus on qualitative data, such as but
not limited to, phenomenology, grounded theory,
and ethnography designs.
Methods
The proposed scoping review will be conducted
following JBI methodology.21,22
Search strategy
The search strategy will aim to locate both published
and unpublished primary studies and reviews. An initial
limited search of PubMed and CINAHL (via EBSCO)
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V. Parola et al.
was undertaken to identify articles on the topic. The
text words contained in the titles and abstracts of
relevant articles, and the index terms used to describe
the articles were used to develop a full search strategy
for PubMed (see Appendix I). The search strategy,
including all identified keywords and index terms, will
be adapted for each included information source. The
reference lists of articles included in the review will be
screened for additional papers.
The databases to be searched will include CINAHL
Complete (EBSCO), MEDLINE (PubMed), Scopus,
SciELO, Cochrane Library, and PEDro. The search
for unpublished studies will include DART-Europe,
OpenGrey, and RCAAP.
Studies published in English, Spanish, and Portu-
guese from 2009 onward will be considered for
inclusion. The 10-year time frame has been applied
in light of the World Health Organization’s 2002
revision of the definition of palliative care to extend
the concept and make it applicable to all diseases,1,2
and in light of the global crisis (2007–2008), which
forced many health systems to face structural
reform.23-26 Applying this time limitation will more
accurately represent this new reality.
Study selection
Following the search, all identified citations will be
collated and uploaded into Mendeley V1.19.4 (Men-
deley Ltd., Elsevier, Netherlands) and duplicates
removed. Two independent reviewers will then screen
titles and abstracts for assessment against the inclusion
criteria for the scoping review. Studies that could
potentially meet the inclusion criteria will be retrieved
in full text. If the reviewers have uncertainties about the
relevance of a study or if the abstract is unclear, the full
article will be retrieved. The full text of selected studies
will be retrieved and assessed in detail against the
inclusion criteria. Full-text studies that do not meet
the inclusion criteria will be excluded, and reasons for
exclusion will be provided in an appendix in the final
report of the scoping review. The results of the search
will be reported in full in the final report and presented
in a Preferred Reporting Items for Systematic Reviews
and Meta-Analyses Extension for Scoping Reviews
(PRISMA-ScR) flow diagram.27 Any disagreements
that arise between the reviewers will be resolved
through discussion or with a third reviewer.
Studies identified from reference list searches will
be assessed for relevance based on the study’s title
and abstract.
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Data extraction
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Data will be extracted from papers included in the
review using a charting table aligned to the objective
and question of this research (Appendix II), as
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indicated by the methodology for scoping reviews
developed by JBI.21
The draft data extraction tool will be modified as
required throughout the review, depending on the
data extracted from the included studies.21 These
modifications will be documented in the full scoping
review report. Two reviewers will extract data inde-
pendently. Any disagreements that arise between the
reviewers will be resolved through discussion or with
a third reviewer.
The two reviewers, independent of each other, will
chart the ‘‘first five to ten studies using the data-
charting form and meet to determine whether their
approach to data extraction is consistent with the
research question and purpose,’’ as suggested by
Levac et al.28(p.6) Authors will be contacted for further
information/clarification of the data where required,
as suggested by Arksey and O’Malley’s framework.29
Data analysis and presentation
The extracted data will be presented in diagram-
matic or tabular form in a manner that aligns with
the objective of this scoping review. A descriptive
summary will accompany the tabulated and/or
charted results and will describe how the results
relate to the review’s objective and question.
A summary of each article will include the
author(s), year of publication, country of origin,
purpose, population, sample size, methodology, con-
cepts of interest, and key findings relating to the
scoping review questions (Appendix III).
Acknowledgments
The University Fernando Pessoa, Faculty of Health
Sciences, Porto and the Health Sciences Research
Unit: Nursing (UICISA: E), hosted by the Nursing
School of Coimbra (ESEnfC) for their support.
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Appendix I: Search strategy

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MEDLINE (PubMed)
Search conducted in December 2019
1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 01/14/2024

Search Query Records retrieved

#1 ((((((((((((nurse[Title/Abstract] OR nurses[Title/Abstract])) OR nurse[MeSH Terms]) 796,268
OR Physicians[MeSH Terms]) OR (physician[Title/Abstract] OR physicians[Title/
Abstract])) OR social worker[MeSH Terms]) OR (social worker[Title/Abstract] OR
social workers[Title/Abstract])) OR psychologists[MeSH Terms]) OR (psychologist
[Title/Abstract] OR psychologists[Title/Abstract])) OR (physiotherapist[Title/
Abstract] OR physiotherapists[Title/Abstract])) OR physiotherapists[MeSH Terms])
OR (occupational therapist[Title/Abstract] OR occupational therapists[Title/
Abstract])) OR Occupational Therapists[MeSH Terms]
#2 (((rehabilitation[Title/Abstract]) OR Rehabilitation[MeSH Terms])) OR rehabilita- 403,760
tions[Title/Abstract]
#3 ((((hospice[Title/Abstract] OR hospices[Title/Abstract])) OR hospices[MeSH Terms]) 131,596
OR palliative care[MeSH Terms]) OR (palliative[Title/Abstract] OR palliatives[Title/
Abstract])
#4 (((((((((((((((nurse[Title/Abstract] OR nurses[Title/Abstract])) OR nurse[MeSH 387
Terms]) OR Physicians[MeSH Terms]) OR (physician[Title/Abstract] OR physicians
[Title/Abstract])) OR social worker[MeSH Terms]) OR (social worker[Title/Abstract]
OR social workers[Title/Abstract])) OR psychologists[MeSH Terms]) OR
(psychologist[Title/Abstract] OR psychologists[Title/Abstract])) OR (physiothera-
pist[Title/Abstract] OR physiotherapists[Title/Abstract])) OR physiotherapists
[MeSH Terms]) OR (occupational therapist[Title/Abstract] OR occupational ther-
apists[Title/Abstract])) OR Occupational Therapists[MeSH Terms])) AND
((((rehabilitation[Title/Abstract]) OR Rehabilitation[MeSH Terms])) OR rehabilita-
tions[Title/Abstract])) AND (((((hospice[Title/Abstract] OR hospices[Title/
Abstract])) OR hospices[MeSH Terms]) OR palliative care[MeSH Terms]) OR
(palliative[Title/Abstract] OR palliatives[Title/Abstract]))
#5 Filter: Since 01/01/2009 208
#6 Filters: Languages – Portuguese; Spanish; English 189
(((((((((((((((nurse[Title/Abstract] OR nurses[Title/Abstract])) OR nurse[MeSH
Terms]) OR Physicians[MeSH Terms]) OR (physician[Title/Abstract] OR physician-
s[Title/Abstract])) OR social worker[MeSH Terms]) OR (social worker[Title/
Abstract] OR social workers[Title/Abstract])) OR psychologists[MeSH Terms]) OR
(psychologist[Title/Abstract] OR psychologists[Title/Abstract])) OR (physiothera-
pist[Title/Abstract] OR physiotherapists[Title/Abstract])) OR physiotherapists
[MeSH Terms]) OR (occupational therapist[Title/Abstract] OR occupational
therapists[Title/Abstract])) OR Occupational Therapists[MeSH Terms])) AND
((((rehabilitation[Title/Abstract]) OR Rehabilitation[MeSH Terms])) OR rehabilita-
tions[Title/Abstract])) AND (((((hospice[Title/Abstract] OR hospices[Title/
Abstract])) OR hospices[MeSH Terms]) OR palliative care[MeSH Terms]) OR
(palliative[Title/Abstract] OR palliatives[Title/Abstract])) Filters: Publication date
from 2009/01/01; Portuguese; English; Spanish

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Appendix II: Data extraction instrument

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Author(s)
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Year of publication
Country of origin
Aims
Context (palliative care unit or hospice)
Palliative rehabilitation intervention
Duration of the intervention
Frequency of the intervention
Concept(s) of significance to the review question
Domain
Health care professional (implementation)
Study population (oncology and non-oncology
patients) and sample size

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Appendix III: Data presentation templates

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Template data presentation for Questions 1 and 2

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Palliative rehabilitation intervention

Respiratory Cardiac Physical
Domains kinesiotherapy rehabilitation rehabilitation Gait reeducation (. . .)
Physical
Cognitive
Emotional

Template data presentation for Question 3

Palliative rehabilitation intervention

Respiratory Cardiac Physical
Characteristics of intervention kinesiotherapy rehabilitation rehabilitation Gait reeducation (. . .)
Duration of intervention
Frequency of intervention
Dose

Template data presentation for Question 4

Palliative rehabilitation intervention

Respiratory Cardiac Physical
Health care professionals kinesiotherapy rehabilitation rehabilitation Gait reeducation (. . .)
Physicians
Registered nurses
Physiotherapists
Psychologists
Social workers
Occupational therapists
(. . .)

Template data presentation for Question 5

Palliative rehabilitation intervention

Respiratory Cardiac Physical
Advanced diseases kinesiotherapy rehabilitation rehabilitation Gait reeducation (. . .)
Oncology
Non-oncology

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