Investigation of the effects of preoperative physical therapy on pulmonary function and physical performance before and after upper abdominal surgery.
Design:
Non-blind randomized controlled trial.
Setting:
Tertiary public hospital and private university, São Paulo state, Brazil.
Subjects:
Thirty-two patients undergoing abdominal surgery.
Interventions:
Patients were randomly assigned to receive physical therapy, with respiratory and global exercises, 2–3 weeks before surgery (treatment group; n = 16) or await operation without engaging in practicing (control group; n = 16). After surgery, a physical therapy protocol was administered to all subjects until the seventh postoperative day.
Main measures:
Pulmonary function outcome variables were inspiratory and expiratory strength, respiratory muscle endurance and spirometry, and physical performance outcome variables were the functional independence measure and 6-minute walk test distance. Any postoperative pulmonary complications were recorded.
Results:
There were no between-group differences at randomization. In the preoperative period, patients in the intervention group had higher inspiratory strength and respiratory muscle endurance than controls (88 cmH2O versus 64 cmH2O and 28 cmH2O versus 23 cmH2O, respectively; P <0 0.05). On the seventh postoperative day, in addition to inspiratory force and respiratory muscle endurance, the intervention group showed better results than controls in the functional independence measure score (118 versus 95) and 6-minute walk test distance (368.5 m versus 223 m), all P <0 0.05. Postoperative pulmonary complications occurred in 11 patients in the control group and five in the intervention group (P = 0.03).
Conclusion:
Preoperative physical therapy improved pulmonary function and physical performance in the pre- and postoperative periods among patients undergoing upper abdominal surgery.
McCoolFDTzelepisGE.Dysfunction of the diaphragm. N Engl J Med2012; 366: 932–942.
2.
GirishMTraynerEJr.DammannOPinto-PlataVCelliB.Symptom-limited stair climbing as a predictor of postoperative cardiopulmonary complications after high-risk surgery. Chest2001; 120: 1147–1151.
3.
KimSHNaSChoiJSNaSHShinSKohSO.An evaluation of diaphragmatic movement by M-mode sonography as a predictor of pulmonary dysfunction after upper abdominal surgery. Anesth Analg2010; 110: 1349–1354.
4.
ScholesRLBrowningLSztendurEMDenehyL.Duration of anaesthesia, type of surgery, respiratory co-morbidity, predicted VO2max and smoking predict postoperative pulmonary complications after upper abdominal surgery: An observational study. Aust J Physiother2009; 55: 191–198.
5.
WattersJMKirkpatrickSMNorrisSBShamjiFMWellsGA.Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility. Ann Surg1997; 226: 369–377; discussion 377–380.
6.
BrowningLDenehyLScholesRL.The quantity of early upright mobilisation performed following upper abdominal surgery is low: an observational study. Aust J Physiother2007; 53: 47–52.
7.
YeoTPBurrellSASauterPK. A progressive postresection walking program significantly improves fatigue and health-related quality of life in pancreas and periampullary cancer patients. J Am Coll Surg2012; 214: 463–475; discussion 475–477.
8.
ChettaATzaniPMarangioECarbognaniPBobbioAOlivieriD.Respiratory effects of surgery and pulmonary function testing in the preoperative evaluation. Acta Biomed2006; 77: 69–74.
9.
BrouquetACudennecTBenoistS. Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Ann Surg2010; 251: 759–765.
10.
CasaliCCPereiraAPMartinezJAde SouzaHCGastaldiAC.Effects of inspiratory muscle training on muscular and pulmonary function after bariatric surgery in obese patients. Obes Surg2011; 21: 1389–1394.
11.
GastaldiACMagalhãesCMBBaraúnaMASilvaEMCSouzaHCD. Benefits of postoperative respiratory kinesiotherapy following laparoscopic cholecystectomy. Rev Bras Fisioter2008; 12: 100–106.
12.
WestwoodKGriffinMRobertsKWilliamsMYoongKDiggerT.Incentive spirometry decreases respiratory complications following major abdominal surgery. Surgeon2007; 5: 339–342.
13.
HanekomSDBrooksDDenehyL. Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: A pragmatic approach to interpret equivocal evidence. BMC Med Inform Decis Mak2012; 12: 5.
14.
PasquinaPTramerMRGranierJMWalderB.Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery: a systematic review. Chest2006; 130: 1887–1899.
15.
ValkenetKvandePortIGDronkersJJde VriesWRLindemanEBackxFJ.The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil2011; 25: 99–111.
16.
DitmyerMMToppRPiferM.Prehabilitation in preparation for orthopaedic surgery. Orthop Nurs2002; 21: 43–51; quiz 52–54.
17.
MayoNEFeldmanLScottS. Impact of preoperative change in physical function on postoperative recovery: Argument supporting prehabilitation for colorectal surgery. Surgery2011; 150: 505–514.
18.
HulzebosEHHeldersPJFavieNJDe BieRABrutel de la RiviereAVan MeeterenNL.Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: A randomized clinical trial. JAMA2006; 296: 1851–1857.
19.
NomoriHKobayashiRFuyunoGMorinagaSYashimaH.Preoperative respiratory muscle training. Assessment in thoracic surgery patients with special reference to postoperative pulmonary complications. Chest1994; 105: 1782–1788.
20.
DronkersJVeldmanAHobergEvan der WaalCvan MeeterenN.Prevention of pulmonary complications after upper abdominal surgery by preoperative intensive inspiratory muscle training: A randomized controlled pilot study. Clin Rehabil2008; 22: 134–142.
21.
CarliFCharleboisPSteinB. Randomized clinical trial of prehabilitation in colorectal surgery. Br J Surg2010; 97: 1187–1197.
22.
DronkersJJLambertsHReutelingspergerIM. Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: A randomized controlled pilot study. Clin Rehabil2010; 24: 614–622.
23.
BorgG.Perceived exertion as an indicator of somatic stress. Scand J Rehab Med1970; 2: 92–98.
24.
OwensWDFeltsJASpitznagelELJr.ASA physical status classifications: A study of consistency of ratings. Anesthesiology1978; 49: 239–243.
25.
ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med2002; 166: 518–624.
26.
NederJAAndreoniSLerarioMCNeryLE. Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res1999; 32: 719–727.
27.
MillerMRHankinsonJBrusascoV. Standardisation of spirometry. Eur Respir J2005; 26: 319–338.
28.
PereiraCASatoTRodriguesSC.New reference values for forced spirometry in white adults in Brazil. J Bras Pneumol2007; 33: 397–406.
29.
OttenbacherKJHsuYGrangerCVFiedlerRC. The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil1996; 77: 1226–1232.
30.
RibertoMMiyazakiMHJucáSSH. Validação da versão brasileira da medida de independência funcional [Validation of the Brazilian version of functional independence measure]. Acta Fisiatr200411: 72–76.
31.
ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med2002; 166: 111–117.
32.
SoaresMRPereiraCA.Six-minute walk test: reference values for healthy adults in Brazil. J Bras Pneumol2011; 37: 576–583.
33.
SaegrovSHaldingAG.What is it like living with the diagnosis of cancer?Eur J Cancer Care (Engl)2004; 13: 145–153.
34.
JonesLWPeddleCJEvesND. Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions. Cancer2007; 110: 590–598.
35.
Barbalho-MoulimMCMiguelGPFortiEMCampos FdoACostaD.Effects of preoperative inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion. Clinics (Sao Paulo)2011; 66: 1721–1727.
36.
KulkarniSRFletcherEMcConnellAKPoskittKRWhymanMR.Pre-operative inspiratory muscle training preserves postoperative inspiratory muscle strength following major abdominal surgery - a randomised pilot study. Ann R Coll Surg Engl2010; 92: 700–707.
37.
WuADrummondGB.Respiratory muscle activity and respiratory obstruction after abdominal surgery. Br J Anaesth2006; 96: 510–515.
38.
NguyenNTLeeSLGoldmanC. Comparison of pulmonary function and postoperative pain after laparoscopic versus open gastric bypass: A randomized trial. J Am Coll Surg2001; 192: 469–476; discussion 476–477.
39.
LawrenceVAHazudaHPCornellJE. Functional independence after major abdominal surgery in the elderly. J Am Coll Surg2004; 199: 762–772.
40.
SinclairRCBatterhamAMDaviesSCawthornLDanjouxGR.Validity of the 6 min walk test in prediction of the anaerobic threshold before major non-cardiac surgery. Br J Anaesth2012; 108: 30–35.
41.
MorielloCMayoNEFeldmanLCarliF.Validating the six-minute walk test as a measure of recovery after elective colon resection surgery. Arch Phys Med Rehabil2008; 89: 1083–1089.
