Hospital school programs ensure educational continuity for children and adolescents during hospitalization, yet the inclusion of physical education (PE) in these settings remains inconsistent and lacks unified standards. PE is widely recognized to confer significant physical, psychosocial, and educational benefits, but it is often omitted from hospital-based education support due to unique contextual constraints. This study protocol presents a comprehensive approach to synthesize evidence and inform practice on PE in hospital schools, encompassing a two-tiered review: Tier 1 is an umbrella review of existing systematic reviews on physical activity interventions for hospitalised youth, and Tier 2 is a systematic review of primary studies evaluating PE delivered in hospital school settings. In parallel, a policy framework analysis will be performed to map national and international regulations governing PE in hospital schools. Multiple databases (including MEDLINE, CINAHL, Embase, PsycINFO, Scopus, and SPORTDiscus) will be searched without language or date restrictions, and supplement with reference checks and expert consultations. Study selection and data extraction will be carried out independently by two reviewers. The quality of included studies and policy documents will be appraised using validated tools such as Cochrane RoB2, ROBINS-I, AMSTAR-2 and AGREE-II. Outcomes of interest include physical, cognitive, psychosocial, clinical, and implementation measures. A narrative synthesis is planned, with meta-analyses conducted if sufficient homogeneous data exist; qualitative findings will be integrated via thematic synthesis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be applied to assess certainty of evidence. This review will provide an evidence base and policy analysis to support the development of guidelines and best practices for implementing PE in hospital schools. PROSPERO ID registration: CRD420251156215.
Ciaccioni et al. (Mon,) studied this question.