Application of Circadian Rhythm-Based Pulmonary Rehabilitation in Patients with Severe Pneumonia-A Feasibility Study With Convenience Sampling.

The study used convenience sampling from a single centre and assigned patients by admission date rather than randomisation, so the groups may not be comparable. The control and intervention groups were admitted in different months and seasons, which could have affected respiratory comfort, compliance or case mix. The intervention was a multi-component bundle, and the authors did not analyse the independent effects of components, so it is not possible to know what part produced the outcomes. Follow-up was short, so long-term effects are unclear. The paper is a feasibility study with a small number of analysed patients, so positive differences should be treated cautiously. The programme relied on a trained multidisciplinary team, daily checklists and supervision, which may not be available in all units.

The investigators reported no financial or nonfinancial disclosures.

Do not conclude that circadian rhythm scheduling alone improved outcomes. The patients received a bundled programme that included airway management, postural management, respiratory muscle training, nutritional support, limb movement training, psychological intervention, family support, sleep-focused care and environment changes, and the authors did not analyse the independent effects of these components. The groups were also assigned by admission date rather than randomisation, so season or baseline differences could contribute.