MSCA HOPE - Physical education in hospital schools: A protocol paper for systematic and umbrella reviews with policy...

Hospital school programs support educational continuity for children and adolescents during hospitalization, but the provision of physical education (PE) remains inconsistent and is rarely addressed by unified standards. This protocol aims to describe the methods for three complementary components designed to synthesise evidence on PE and related movement interventions in hospital settings and to map the policy frameworks governing PE provision in hospital schools. Tier 1 is an umbrella review of existing systematic reviews on physical activity interventions for hospitalised youth. Tier 2 is a systematic review of primary studies examining PE in hospital-school settings. For Tier 2, PE is operationally defined as a planned movement-based learning experience with an explicit educational purpose that is formally integrated into the hospital-school program or involves educational staff in its planning, delivery or assessment. Therapeutic exercise, rehabilitation and active play without this educational connection will be excluded from Tier 2, although they may be represented in Tier 1. A parallel policy framework analysis will identify and compare relevant laws, regulations, curricula, strategies and guidelines. Separate search strategies will be used for each component across health, education, sport and policy sources, without language or date restrictions. Narrative synthesis will be the primary approach. Meta-analysis will be considered only when at least three independent studies are sufficiently comparable in population, intervention, design, outcome construct and assessment time point. Priority synthesis will distinguish implementation/process evidence from effectiveness outcomes. Safety, implementation and educational participation will be synthesised primarily using narrative, qualitative and mixed-method approaches, whereas physical functioning and psychosocial well-being will be prioritised for quantitative effect synthesis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) when sufficiently comparable evidence is available. The planned reviews are intended to clarify the available evidence and policy landscape and may inform subsequent guideline development for PE in hospital schools. PROSPERO registration: CRD420251156215.