# Identifying Key Factors in Adherence and Dropouts in Active Physiotherapy in Children with Acute Leukemia: A Systematic Review with Meta-Analysis and Meta-Regression

## TL;DR

This study finds that exercise modality may influence adherence in children with acute leukemia undergoing physiotherapy, but results are limited due to study heterogeneity.

## Contribution

The study identifies exercise modality as a potential adherence moderator in children with acute leukemia through meta-analysis and meta-regression.

## Key findings

- Strength and gaming-based exercise interventions had lower dropout rates compared to multicomponent programs.
- Exercise modality is highlighted as a potential factor influencing adherence in this population.
- Meta-regression failed to identify consistent moderators of dropout rates due to study heterogeneity.

## Abstract

What are the main findings?
Exercise modality stands out as a potential moderator of adherence in children with acute leukemia.The heterogeneity of the studies prevents to extraction of consistent conclusions about moderators of dropouts in this population.

Exercise modality stands out as a potential moderator of adherence in children with acute leukemia.

The heterogeneity of the studies prevents to extraction of consistent conclusions about moderators of dropouts in this population.

What is the implication of the main finding?
Physiotherapists should select strength or gaming-based protocols for treating this type of patient.The design of active physiotherapy interventions for children with acute leukemia should prioritize motivation to enhance the adherence and outcomes.

Physiotherapists should select strength or gaming-based protocols for treating this type of patient.

The design of active physiotherapy interventions for children with acute leukemia should prioritize motivation to enhance the adherence and outcomes.

Background/Objectives: Adherence to active physiotherapy programs in children suffering from cancer is essential to enhance the improvement generated by the treatment. Therefore, the main aim of this review was to identify the factors influencing adherence and dropout rates in exercise programs applied to children with acute lymphoblastic leukemia. Methods: A systematic review with meta-analysis and meta-regression was conducted. The search was performed using PubMed, Scopus, Embase, SPORTDiscus, and PEDro databases. Eligible studies included randomized controlled trials focusing on determining adherence in active physiotherapy programs compared to standard care. A meta-synthesis was performed together with a random-effects meta-analysis. Furthermore, a proportion meta-analysis was developed, dividing by exercise modality, and a multivariate regression was performed to determine what factors were able to moderate the dropout rates. Results: Thirteen studies were selected, including 654 patients. Of them, 8 studies opt for multicomponent exercise, 3 used strength, and 2 selected virtual reality-based treatment. Overall, dropout rates were similar between groups. However, dropout proportions varied by intervention type, with minor attritions in strength (8.6%) and exergaming interventions (8.7%) compared to multicomponent exercise programs (18.4%). Meta-regression did not identify statistically significant moderators of dropouts. Conclusions: The heterogeneity of the studies in this target population meant that no factor could be identified as a moderator of dropouts, but exercise modality stands out as a potential moderator of adherence. Therefore, future studies should develop and test adherence-enhancing strategies to facilitate clinical implementation.