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

Abstract

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.