BACKGROUND: Inadvertent perioperative hypothermia is a common complication of surgery, and active body surface warming (ABSW) systems are used to prevent adverse clinical outcomes. Prior data on certain outcomes are equivocal (ie, blood loss) or limited (ie, pain and opioid consumption). The objective of this study was to provide an updated review on the effect of ABSW on clinical outcomes and temperature maintenance. METHODS: We conducted a systematic review of randomized controlled trials evaluating ABSW systems compared to nonactive warming controls in noncardiac surgeries. Outcomes studied included postoperative pain scores and opioid consumption (primary outcomes) and other perioperative clinical variables such as temperature changes, blood loss, and wound infection (secondary outcomes). We searched Ovid MEDLINE daily, Ovid MEDLINE, EMBASE, CINHAL, Cochrane CENTRAL, and Web of Science from inception to June 2019. Quality of evidence (QoE) was rated according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Subgroup analysis sought to determine the effect of preoperative + intraoperative warming versus intraoperative warming alone. Metaregression evaluated the effect of year of publication, use of neuromuscular blockers, anesthesia, and surgery type on outcomes. RESULTS: Fifty-four articles (3976 patients) were included. Pooled results demonstrated that ABSW maintained normothermia compared to controls, during surgery (30 minutes postinduction [mean difference {MD}: 0.3°C, 95% confidence interval {CI}, 0.2–0.4, moderate QoE]), end of surgery (MD: 1.1°C, 95% CI, 0.9–1.3, high QoE), and up to 4 hours postoperatively (MD: 0.3°C, 95% CI, 0.2–0.5, high QoE). ABSW was not associated with difference in pain scores (<24 hours postoperatively, moderate to low QoE) or perioperative opioid consumption (very low QoE). ABSW increased patient satisfaction (MD: 2.2 points, 95% CI, 0.9–3.6, moderate QoE), reduced blood transfusions (odds ratio [OR] = 0.6, 95% CI, 0.4–1.0, moderate QoE), shivering (OR = 0.2, 95% CI, 0.1–0.4, high QoE), and wound infections (OR = 0.3, 95% CI, 0.2–0.7, high QoE). No significant differences were found for fluid administration (low QoE), blood loss (very low QoE), major adverse cardiovascular events (very low QoE), or mortality (very low QoE). Subgroup analysis and metaregression suggested increased temperature benefit with pre + intraoperative warming, use of neuromuscular blockers, and recent publication year. ABSW seemed to confer less temperature benefit in cesarean deliveries and neurosurgical/spinal cases compared to abdominal surgeries. CONCLUSIONS: ABSW is effective in maintaining physiological normothermia, decreasing wound infections, shivering, blood transfusions, and increasing patient satisfaction but does not appear to affect postoperative pain and opioid use.

Introduction: Despite aerobic exercise (AE) testing being a key recommendation for stroke rehabilitation, less than half of physical therapists working with individuals post-stroke perform this practice. Concern for adverse cardiovascular events and inadequate guidance on how to conduct AE testing for individuals with stroke and comorbidity are key barriers. This review aims to describe submaximal AE testing protocols with evidence of safety, defined as less than 11% occurrence of serious adverse events, for people with subacute stroke and comorbidity. Methods: MEDLINE, EMBASE, PsycINFO, CINAHL and SPORTDiscus were searched from inception to October 29, 2020. Published studies that involved submaximal AE testing with individuals with subacute stroke and reported on adverse events during testing were included. Two reviewers independently conducted title and abstract, and full-text screening. One reviewer conducted data extraction, verified by a second reviewer. Results: Sixteen studies involving 595 participants were included. Hypertension (35%), cardiovascular disease (14%) and atrial fibrillation (8%) were the most common cardiovascular comorbidities, while, diabetes (25%), dyslipidemia (23%) and smoking history (11%) were the most common general comorbidities affecting participants with stroke. Evidence of safety for individuals with stroke and comorbidity was found for incremental bicycle (n=5), recumbent stepper (n=3), body weight support treadmill (n=1) and upper extremity ergometer (n=1) protocols; constant load bicycle (n=1) and body weight support treadmill (n=1) protocols; and field (n=10) protocols. Heart rate (95%), blood pressure (82%) and oxygen consumption (72%) monitoring were most frequently done. Test termination criteria based on volition/fatigue (59%) and heart rate (55%) were most commonly reported. Conclusion: A range of submaximal AE testing protocols utilizing diverse exercise modalities can be safely conducted on people with subacute stroke and comorbid conditions that are perceived to increase the risk for serious adverse events. These protocols can be used to guide the development of more specific clinical practice guidelines for conducting AE testing on individuals with stroke and comorbidity.

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Background and Purpose: Concern for adverse cardiovascular events and limited guidance regarding how to conduct aerobic exercise (AEx) testing for individuals poststroke are key barriers to implementation by physical therapists in stroke rehabilitation. This study aimed to describe the nature and safety of submaximal AEx testing protocols for people with subacute stroke (PwSS) and the nature of comorbidity of PwSS who underwent submaximal AEx testing. Methods: We conducted a scoping review and searched MEDLINE, EMBASE, PsycINFO, CINAHL, and SPORTDiscus from inception to October 29, 2020. Studies involving submaximal AEx testing with PwSS, reporting on participant comorbidity and on adverse events during testing, were eligible. Two reviewers independently conducted title and abstract and full-text screening. One reviewer extracted data; a second reviewer verified data. Results: Thirteen studies involving 452 participants and 19 submaximal AEx testing protocols (10 field test, 7 incremental, and 2 constant load) were included. Hypertension (41%), diabetes (31%), and dyslipidemia (27%) were the most common comorbidities reported. No protocols resulted in a serious adverse event. The most