The effect of physical therapy on respiratory complications following cardiac valve surgery. Randomized Controlled Study to Evaluate the Efficacy of a Preoperative Respiratory Rehabilitation Program to Prevent Postoperative Pulmonary Complications after Esophagectomy Preoperative exercise training prevents functional decline after lung resection surgery: a randomized, single-blind controlled trial Physical conditioning and mental stress reduction - a randomised trial in patients undergoing cardiac surgery Preoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery. Cardiac rehabilitation after myocardial infarction. The prevention of pulmonary complications after upper abdominal surgery in patients with noncompromised pulmonary status. Efficacy of breathing and coughing exercises in the prevention of pulmonary complications after coronary artery surgery. Postoperative physical therapy after coronary artery bypass surgery. Perioperative rehabilitation and physiotherapy for lung cancer patients with chronic obstructive pulmonary disease. Effect of a preoperative protocol of aerobic physical therapy on the quality of life of patients with adolescent idiopathic scoliosis: a randomized clinical study. [Prevention of postoperative pulmonary complications after heart-lung surgery. Comparison of 3 different mask physiotherapy regimens]. The effectiveness of incentive spirometry with physical therapy for high-risk patients after coronary artery bypass surgery. Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection: a pilot randomized controlled trial. Does removal of deep breathing exercises from a physiotherapy program including pre-operative education and early mobilisation after cardiac surgery alter patient outcomes? Preoperative pulmonary evaluation and therapy for surgery patients. Pulmonary function and physical performance outcomes with preoperative physical therapy in upper abdominal surgery: a randomized controlled trial
STUDY OBJECTIVE To determine whether higher personnel intensive chest physical therapy can prevent the atelectasis that routinely follows cardiac valve surgery . DESIGN R and omized , controlled trial . SETTING Tertiary care hospital . PATIENTS Seventy-eight patients undergoing elective cardiac valve surgery between October 1991 and April 1993 were enrolled . INTERVENTIONS Patients were r and omized in an unmasked fashion to receive early mobilization and sustained maximal inflations ( lower-intensity treatment ) or to receive early mobilization , sustained maximal inflations , and single-h and ed percussions ( higher-intensity treatment . ) MEASUREMENTS AND RESULTS Clinical efficacy was determined by extent of atelectasis , length of ICU stay , total length of hospital stay , and personnel costs . The extent of postoperative atelectasis was similar in both groups on the fifth postoperative day . Postoperative values of FVC and FEV1 were reduced to a similar extent in both groups . Hospital stays and ICU stays were similar regardless of treatment . Physical therapy costs were highest in the higher-intensity therapy group . CONCLUSIONS Postoperative respiratory dysfunction is common but does not usually cause significant morbidity or prolong hospital stay . The routine prescription of high-intensity physical therapy does not improve patient outcomes but does add significantly to patient costs Background / Aims : Patients with postoperative pulmonary complications after esophagectomy often have increased mortality . The purpose of the study was to examine the efficacy of preventing postoperative pulmonary complications by an intensive preoperative respiratory rehabilitation ( PR ) program for esophageal cancer patients . Methods : This study was a prospect i ve r and omized controlled study . Thirty patients in the PR group and 30 patients in the no preoperative respiratory rehabilitation ( NPR ) group were included . The PR group received preoperative rehabilitation for more than 7 days , while the NPR group did not receive any preoperative rehabilitation . All patients underwent postoperative rehabilitation from the first postoperative day . The postoperative pulmonary complications were evaluated using the Clavien-Dindo classification ( CDC ) and the Utrecht Pneumonia Scoring System ( UPSS ) . Results : The CDC grade in the PR group was significantly lower than that in the NPR group ( p = 0.014 ) . The UPSS score in the PR group was significantly lower than that in the NPR group at postoperative day 1 ( p = 0.031 ) . In the multivariate analysis , NPR was an independent risk factor for postoperative pulmonary complications greater than CDC grade II ( OR : 3.99 , 95 % CI : 1.28 - 12.4 , p = 0.017 ) . Conclusions : This study showed that the intensive PR program was capable of reducing the postoperative pulmonary complications in esophageal cancer patients Objectives : To investigate the effects of a preoperative pulmonary rehabilitation programme in patients with lung cancer undergoing video-assisted thoracic surgery .  Design : R and omized , single-blind controlled trial . Setting : Teaching hospital . Subjects : Patients with suspected or confirmed lung cancer undergoing video-assisted thoracic surgery .  Intervention : Participants were r and omized  to either a prehabilitation group or a control group .  Participants in the prehabilitation group underwent a combination of moderate endurance and resistance training plus breathing exercises three to five times per week . Main measures : The primary outcome of the study was exercise capacity . Secondary outcomes were muscle strength ( Senior Fitness Test ) , health-related quality of life ( Short-Form 36 ) and the postoperative outcomes . Patients were evaluated at baseline ( before r and omization ) , presurgery ( only the prehabilitation group ) , after surgery and three months post-operatively . Results : A total of 40 patients were r and omized and 22 finished the study ( 10 in the prehabilitation group and 12 in the control group ) . Three patients were lost to follow-up at three months . After the training , there was a statistically significant improvement in exercise tolerance ( + 397 seconds , p = 0.0001 ) , the physical summary component of the SF-36 ( + 4.4 points , p = 0.008 ) and muscle strength ( p < 0.01 ) . There were no significant differences between groups after surgery . However , three months postoperatively , significant differences were found in the mean change of exercise capacity ( p = 0.005 ) , physical summary component ( p = 0.001 ) and upper and lower body strength ( p = 0.045 and p = 0.002 ) . Conclusions : A pulmonary rehabilitation programme before video-assisted thoracic surgery seems to improve patients ’ preoperative condition and may prevent functional decline after surgery . Clinical Registration Number : NCT01963923 ( Registration date 10/10/2013 Background Preoperative anxiety and physical unfitness have been shown to have adverse effects on recovery from cardiac surgery . This study involving cardiac surgery patients was primarily aim ed at assessing the feasibility of delivering physical conditioning and stress reduction programs within the public hospital setting . Secondary aims were to evaluate the effect of these programs on quality of life ( QOL ) , rates of postoperative atrial fibrillation ( AF ) and length of stay ( LOS ) in hospital . Methods Elective patients scheduled for coronary artery bypass graft and /or valve surgery at a public hospital in Melbourne , Australia were enrolled . Patients were r and omized to receive either holistic therapy ( HT ) or usual care ( UC ) . HT consisted of a series of light physical exercise sessions together with a mental stress reduction program administered in an outpatient setting for the first two weeks after placement on the waiting list for surgery . A self-administered SF-36 question naire was used to measure QOL and hospital records to collect data on LOS and rate of postoperative AF . Results The study population comprised 117 patients of whom 60 received HT and 57 received UC . Both programs were able to be delivered within the hospital setting but ongoing therapy beyond the two week duration of the program was not carried out due to long waiting periods and insufficient re sources . HT , as delivered in this study , compared to UC did not result in significant changes in QOL , LOS or AF incidence . Conclusions Preoperative holistic therapy can be delivered in the hospital setting , although two weeks is insufficient to provide benefits beyond usual care on QOL , LOS or postoperative AF . Further research is now required to determine whether a similar program of longer duration , or targeted to high risk patients can provide measurable benefits .Trial registration This trial was conducted as part of a larger study and according to the principles contained in the CONSORT statement 2001 OBJECTIVE To evaluate the occurrence and risk of pulmonary complications in children who underwent pre- and postoperative physiotherapeutic intervention in cardiac surgeries , as well as to compare these patients to those who underwent only postoperative physiotherapeutic intervention . METHODS A r and omized controlled trial was performed with 135 patients from 6 years of age and younger with congenital heart disease who had undergone cardiac surgery . Patients were r and omly assigned to the intervention group ( G1 ) in which they underwent pre- and postoperative physiotherapy or to the control group ( G2 ) in which they underwent only postoperative physiotherapy . Mann-Whitney and the Chi-square tests were used to compare the variables between the groups . The magnitude of the absolute risk was calculated by the number of patients needed to treat . Statistical significance was set at 5 % ( P<0.05 ) . RESULTS 17 patients ( 25 % ) in G1 , and 29 patients ( 43.3 % ) in G2 presented pulmonary complications ( P= 0.025 ) , pneumonia was the most frequent complication , and among the 17 patients in G1 , seven ( 10.3 % ) developed pneumonia , six ( 8.8 % ) developed atelectasis , and four ( 5.9 % ) presented complications due to both complications . In G2 , 13 patients ( 19.4 % ) developed pneumonia , eight ( 11.9 % ) developed atelectasis , and eight ( 11.9 % ) developed pneumonia associated with atelectasis . Absolute risk reduction for the primary outcome was of 18.3 % and the number of needed to treat was 5.5 . CONCLUSION Preoperative respiratory physiotherapy significantly reduced the risk of pulmonary complications in postoperative pediatric cardiac surgery Cardiac rehabilitation/ secondary prevention programs are recognized as integral to the comprehensive care of patients with coronary heart disease ( CHD ) , and as such are recommended as useful and effective ( Class I ) by the American Heart Association and the American College of Cardiology in the treatment of patients with CHD . The term cardiac rehabilitation refers to coordinated , multifaceted interventions design ed to optimize a cardiac patient 's physical , psychological , and social functioning , in addition to stabilizing , slowing , or even reversing the progression of the underlying atherosclerotic processes , thereby reducing morbidity and mortality . Cardiac rehabilitation , aims at returning the patient back to normal functioning in a safe and effective manner and to enhance the psychosocial and vocational state of the patient . The program involves education , exercise , risk factor modification and counselling . A meta- analysis based on a review of 48 r and omized trials that compared outcomes of exercise-based rehabilitation with usual medical care , showed a reduction of 20 % in total mortality and 26 % in cardiac mortality rates , with exercise-based rehabilitation compared with usual medical care . Risk stratification helps identify patients who are at increased risk for exercise-related cardiovascular events and who may require more intensive cardiac monitoring in addition to the medical supervision provided for all cardiac rehabilitation program participants . During exercise , the patients ' ECG is continuously monitored through telemetry , which serves to optimize the exercise prescription and enhance safety . The safety of cardiac rehabilitation exercise programs is well established , and the occurrence of major cardiovascular events during supervised exercise is extremely low . As hospital stays decrease , cardiac rehabilitation is assuming an increasingly important role in secondary prevention . In contrast with its growing importance internationally , there are very few cardiac rehabilitation centers in India at the present moment Controversy exists regarding the routine use of breathing exercises in the prevention of pulmonary complications after upper abdominal surgery . We prospect ively r and omized 153 patients who had noncompromised pulmonary status ; the control group ( 84 patients ) engaged in no breathing exercises , and the respiratory therapy group ( 69 patients ) engaged in preoperative and postoperative breathing exercises supervised by the physical therapist .  Postoperative pulmonary complications were classified using criteria derived from chest roentgenograms , arterial blood gas sample s , and temperature registration . The incidences of postoperative complications in the treatment group and in the control groups were 19 % and 60 % , respectively . In the present study , preoperative lung function tests had no additional or predictive value . We advise preoperative and postoperative breathing exercises as a prophylactic treatment in all patients scheduled for upper abdominal surgery One hundred twenty patients undergoing coronary artery surgery completed a r and omized controlled study design ed to investigate whether prophylactic chest physiotherapy affected the incidence of postoperative pulmonary complications . Group 1 patients received no preoperative or postoperative chest physiotherapy . Group 2 patients received preoperative education and instruction in breathing and coughing exercises and postoperative supervision and assistance in performing the same . These exercises were supervised by a physiotherapist twice per day on the first 2 postoperative days and once per day on the 3rd and 4th postoperative days . Physiotherapy for group 3 patients was the same as for group 2 patients except that patients were seen by a physiotherapist 4 times per day on the first 2 postoperative days and twice per day on the 3rd and 4th postoperative days . Group 2 and 3 patients were instructed to practice breathing and coughing exercises every hour . Overall , an incidence of clinical ly significant postoperative pulmonary complications of 7.5 percent was demonstrated . In general , these patients demonstrated lower levels of preoperative pulmonary function and very low early postoperative oxygenation compared with those who did not develop pulmonary complications . There was no indication that the incidence or severity of fever , hypoxemia , chest roentgenologic abnormalities or clinical ly significant postoperative pulmonary complications was different between groups . These results suggest that the necessity for prophylactic chest physiotherapy after routine coronary artery surgery should be review ed Coronary artery bypass surgery is frequently complicated by postoperative atelectasis . Although routinely prescribed , the efficacy of any specific chest physical therapy is not well established . We studied patients at a university center undergoing elective coronary artery bypass surgery . Based upon chest X-ray criteria at extubation , patients ( n = 228 ) were classified as demonstrating greater or lesser degrees of atelectasis . Those with a lesser degree of atelectasis were r and omized to receive either early mobilization or sustained maximal inflations ( SMI ) . Those with greater a degree of atelectasis were separately r and omized to receive either SMI or single-h and ed percussions ( SSP ) . We found the extent of atelectasis at extubation did not predict the risk of developing pneumonia . Hospital stays and intensive care unit stays were similar regardless of treatment . Physical therapy costs were highest in the most labor-intensive therapy group ( SSP ) . We conclude that postoperative respiratory dysfunction is common but does not commonly cause significant morbidity or prolong hospital stay . Adding SMI to patients with minimal atelectasis at extubation does not improve clinical outcomes . Similarly , adding SSP to patients with marked atelectasis does not improve outcomes over those obtained with SMI and early ambulation OBJECTIVE The purpose of this study was to investigate the impact of pulmonary rehabilitation on surgical morbidity and lung function in lung cancer patients with chronic obstructive pulmonary disease ( COPD ) . METHODS Prospect ively , 22 lung cancer patients with COPD who underwent lobectomy between 2000 and 2003 were enrolled for this study as a rehabilitation group (  Rehab . Group ) . The criteria of COPD were preoperative forced expiratory volume in 1 second (FEV1)/forced vital capacity ( FVC ) < or = 70 % and more than 50 % of low attenuation area in a computed tomography . Preoperatively patients performed aggressive pulmonary exercise for two weeks and received chest physiotherapy postoperatively .  As a historical control , 60 patients with lung cancer who fulfilled the same criteria but did not receive rehabilitation between 1995 and 1999 ( control group ) were entered in this study . RESULTS Patient background s were all equivalent between the two groups . However , FEV1 and FEV1/FVC were significantly lower in the Rehab . Group ( p < 0.05 ) . Prolonged oxygen supplement and tracheostomy tended to be more frequent in the control group . The ratio of actual postoperative to predicted postoperative FEV1 was significantly better in the Rehab . Group ( p = 0.047 ) . Furthermore , postoperative hospital stay was significantly longer in the control group ( p = 0.0003 ) . CONCLUSION Despite lower FEV1 and FEV1/FVC in the Rehab . Group , postoperative pulmonary complications and long hospital stay could be effectively prevented and FEV1 was well preserved by rehabilitation and physiotherapy Patients with adolescent idiopathic scoliosis ( AIS ) have lower potential for physical activity because of lung dysfunction and lower muscle strength , which can be reversed by the cardiorespiratory and musculoskeletal conditioning provided by st and ardized physical activities . We conducted a study to determine if a preoperative protocol of aerobic exercise would improve quality of life ( QoL ) both before and after training and if there would be any differences between patients who received the therapy and those who did not . Patients with the indication of surgical correction of AIS were r and omized to receive or not receive a 4-month preoperative course of aerobic physical training . At baseline and after 4 months , they were evaluated with the Short Form-36 question naire ( SF-36 ) . QoL scores improved for the study group but did not change for the control group . In all QoL domains , the study group 's mean score increased significantly between baseline and 4 months . We concluded that the proposed preoperative physical therapy protocol improved the QoL of patients with AIS The object of the investigation was to compare the effect of three different physiotherapy masks on the incidence of postoperative complications after thoracic surgery . It was carried out as a prospect i ve , consecutive , r and omized comparison at a Department of Thoracic and Heart Surgery at a University Hospital . The therapy was performed by experienced and specially trained physiotherapists . One hundred and sixty patients were evaluated ; 60 patients undergoing heart surgery , 59 patients having pulmonary resection , and 41 patients with exploratory thoracotomy . In each operative category the patients were treated with one of three face mask systems used in addition to routine chest physiotherapy . These were either continuous positive airway pressure ( CPAP ) , positive expiratory pressure ( PEP ) , or inspiratory resistance -- positive expiratory pressure ( IR-PEP ) . Postoperative pulmonary complications were assessed by forced vital capacity ( FVC ) , arterial oxygen tension ( PaO2 ) , and chest X-ray examination , all parameters were measured preoperatively and on the fourth and ninth postoperative day . The patients filled in a question naire concerning their opinions about their mask treatment . IR-PEP showed a lesser decrease in PaO2 on day nine . Otherwise there was an equal decrease in FVC and PaO2 , and equal frequency of atelectasis in the three mask treatments . It is therefore concluded that any of the three therapies : continuous positive airway pressure ( CPAP ) , positive expiratory pressure ( PEP ) , and inspiratory resistance -- positive expiratory pressure ( IR-PEP ) may be used as supplement to st and ard chest physiotherapy BACKGROUND AND PURPOSE The purpose of this study was to determine whether the addition of incentive spirometry ( IS ) to postoperative pulmonary physical therapy is more effective than physical therapy alone in reducing postoperative pulmonary complications in high-risk patients after coronary artery bypass grafting ( CABG ) . Patients were given the spirometer and instructed in its use , as often occurs in clinical setting s. SUBJECTS Patients with chronic airflow limitation following CABG ( N = 185 ) participated . METHODS Subjects were r and omly assigned to receive either postoperative pulmonary physical therapy ( breathing exercises , secretion removal , mobility ) or physical therapy combined with IS . RESULTS No difference was found between the two groups in atelectasis , spirometry , oxygen saturation , pulmonary infection , or hospital stay . CONCLUSION AND DISCUSSION Incentive spirometry combined with physical therapy is no more effective than postoperative physical therapy alone in reducing atelectasis for this population . Use of the spirometer , however , was not monitored , and although the study mimicked practice as it often occurs , the effectiveness of the spirometer can not be fully evaluated OBJECTIVE To evaluate the effect of 4 weeks of pulmonary rehabilitation ( PR ) versus chest physical therapy ( CPT ) on the preoperative functional capacity and postoperative respiratory morbidity of patients undergoing lung cancer resection . DESIGN R and omized single-blinded study . SETTING A teaching hospital . PARTICIPANTS Patients undergoing lung cancer resection ( N=24 ) . INTERVENTIONS Patients were r and omly assigned to receive PR ( strength and endurance training ) versus CPT ( breathing exercises for lung expansion ) . Both groups received educational classes . MAIN OUTCOME MEASURES Functional parameters assessed before and after 4 weeks of PR or CPT ( phase 1 ) , and pulmonary complications assessed after lung cancer resection ( phase 2 ) . RESULTS Twelve patients were r and omly assigned to the PR arm and 12 to the CPT arm . Three patients in the CPT arm were not su bmi tted to lung resection because of inoperable cancer . During phase 1 evaluation , most functional parameters in the PR group improved from baseline to 1 month : forced vital capacity ( FVC ) ( 1.47L [ 1.27 - 2.33L ] vs 1.71L [ 1.65 - 2.80L ] , respectively ; P=.02 ) ; percentage of predicted FVC ( FVC% ; 62.5 % [ 49%-71 % ] vs 76 % [ 65%-79.7 % ] , respectively ; P<.05 ) ; 6-minute walk test ( 425.5±85.3 m vs 475±86.5 m , respectively ; P<.05 ) ; maximal inspiratory pressure ( 90±45.9cmH(2)O vs 117.5±36.5cmH(2)O , respectively ; P<.05 ) ; and maximal expiratory pressure ( 79.7±17.1cmH(2)O vs 92.9±21.4cmH(2)O , respectively ; P<.05 ) . During phase 2 evaluation , the PR group had a lower incidence of postoperative respiratory morbidity ( P=.01 ) , a shorter length of postoperative stay ( 12.2±3.6d vs 7.8±4.8d , respectively ; P=.04 ) , and required a chest tube for fewer days ( 7.4±2.6d vs 4.5±2.9d , respectively ; P=.03 ) compared with the CPT arm . CONCLUSIONS These findings suggest that 4 weeks of PR before lung cancer resection improves preoperative functional capacity and decreases the postoperative respiratory morbidity The aim of this study was to establish whether removal of breathing exercises from a regimen including early mobilisation changes the incidence of post-operative pulmonary complications for patients after cardiac surgery . Two hundred and thirty patients undergoing open heart surgery at Monash Medical Centre , Melbourne , were enrolled in this r and omised controlled trial . All patients received physiotherapy treatment pre-operatively and post-operatively for three days . Patients were mobilised as soon as possible after surgery . Breathing group ( control ) patients performed a set routine of deep breathing exercises at each physiotherapy visit while those in the intervention group did not perform this routine . Other than the breathing exercises , patient management was similar between groups in terms of assessment , positioning and mobility . The incidence of postoperative pulmonary complications , post-operative length of stay , oxyhaemoglobin saturation and pulmonary function were measured pre-operatively and post-operatively . Intention-to-treat analysis was performed for post-operative pulmonary complications and length of stay . Other data were analysed using t-tests , chi square and repeated measures analysis of variance . There were no significant differences between the groups in the primary dependent variables . It is concluded that removal of breathing exercises from the routine physiotherapy management of open heart surgery patients does not significantly alter patient outcome Simple pulmonary function studies can be utilized successfully for diagnosis of pulmonary problems in surgery patients preoperatively . In the present study , r and omly selected " poor risk " patients were treated preoperatively and postoperatively with cessation of smoking , bronchodilator drugs , antibiotics , inhalation of humidified gases , segmental postural drainage , and chest physiotherapy . When compared to nontreated poor risk patients , the treated patients had a marked reduction in postoperative morbidity and mortality due to pulmonary complications . Although the frequency and the severity of pulmonary complications were somewhat greater in the treated patients than in a group of " good risk " patients who were considerably younger in age , the differences were not significant . Extension of these simple therapeutic measures to large numbers of poor risk patients should reduce postoperative morbidity and mortality , allow earlier discharge , and lower the costs of patient care Objective : Investigation of the effects of preoperative physical therapy on pulmonary function and physical performance before and after upper abdominal surgery . Design : Non-blind r and omized controlled trial . Setting : Tertiary public hospital and private university , São Paulo state , Brazil . Subjects : Thirty-two patients undergoing abdominal surgery . Interventions : Patients were r and omly 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 r and omization . 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
Evidence derived from small trials suggests that preoperative physical therapy reduces postoperative pulmonary complications ( atelectasis and pneumonia ) and length of hospital stay in patients undergoing elective cardiac surgery .
There is a lack of evidence that preoperative physical therapy reduces postoperative pneumothorax , prolonged mechanical ventilation or all-cause deaths
BACKGROUND After cardiac surgery , physical therapy is a routine procedure delivered with the aim of preventing postoperative pulmonary complications .
OBJECTIVES To determine if preoperative physical therapy with an exercise component can prevent postoperative pulmonary complications in cardiac surgery patients , and to evaluate which type of patient benefits and which type of physical therapy is most effective .