- Original article
- Open Access
Preoperative respiratory physical therapy program as a prehabilitation to improve inspiratory muscle function and quality of life in patients undergoing upper abdominal surgeries: a prospective randomized controlled trial
Bulletin of Faculty of Physical Therapy volume 21, pages17–22(2016)
Respiratory complications are the most common complications after surgery.
The aim of this study was to evaluate the efficacy of preoperative respiratory physical therapy program in improving inspiratory muscle function and quality of life (QoL) in patients undergoing upper abdominal surgeries.
Patients and methods
Forty patients undergoing upper abdominal surgeries were selected from Kasr El-Aini Hospital; their ages ranged from 25 to 45 years. Patients were randomly assigned to the control or the physical therapy group. Only the physical therapy group received the preoperative chest physical therapy program. All treatment interventions were applied at a frequency of 6 days/week for 2 weeks. Outcome measures included maximum inspiratory pressure as a primary outcome measure and QoL scores as a secondary outcome measure. All outcome measures were measured for all patients 2 weeks before surgery, 24h before surgery, and 24h after surgery.
Level of maximum inspiratory pressure and QoL scores were higher in the physical therapy group compared with the control group (P<0.05).
It was concluded that preoperative respiratory physical therapy improves inspiratory muscle strength and QoL scores in patients undergoing upper abdominal surgeries.
Kanat F, Golcuk A, Teke T, Golcuk M. Risk factors for postoperative pulmonary complications in upper abdominal surgery. ANZ J Surg 2007;77:135–141.
Smetana GW. Postoperative pulmonary complications: an update on risk assessment and reduction. Cleve Clin J Med 2009;76:Suppl 4:S60–S65.
Waissman C. Pulmonary complications after cardiac surgery. Semin Cardiothorac Vasc Anesth 2004;8:185–211.
Qaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW et al. Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med 2006;144:575–580.
Relan M, Kancha RK. Perioperative assessment and management of the patient with pulmonary disease. Northeast Florida Med 2008;59:19–22.
Smetana GW, Lawrence VA, Cornell JE, American College of Physicians. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 2006;144:581–595.
Dronkers J, Veldman A, Hoberg E, van der Waal C, van Meeteren N. Prevention of pulmonary complications after upper abdominal surgery by preoperative intensive inspiratory muscle training: a randomized controlled pilot study. Clin Rehabil 2008;22:134–142.
Bartlett RH, Gazzaniga AB, Geraghty TR. Respiratory maneuvers to prevent postoperative pulmonary complications. A critical review. JAMA 1973;224:1017–1021.
O’Connor M, Tattersall MP, Carter JA. An evaluation of the incentive spirometer to improve lung function after cholecystectomy. Anaesthesia 1988;43:785–787.
Duggan M, Kavanagh BP. Perioperative modifications of respiratory function. Best Pract Res Clin Anaesthesiol 2010;24:145–155.
Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J et al. ARISCAT Group Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 2010;113:1338–1350.
Weiner P, Zeidan F, Zamir D, Pelled B, Waizman J, Beckerman M, Weiner M. Prophylactic inspiratory muscle training in patients undergoing coronary artery bypass graft. World J Surg 1998;22:427–431.
Chou CL, Chang CL. The relationship of quality of life and peak V&O2 in patients short-term after coronary artery bypass graft. Tw J Phys Med Rehabil 2007;35:99–104.
Reeve JC, Nicol K, Stiller K, McPherson KM, Birch P, Gordon IR, Denehy L. Does physiotherapy reduce the incidence of postoperative pulmonary complications following pulmonary resection via open thoracotomy? A preliminary randomised single-blind clinical trial. Eur J Cardiothorac Surg 2010;37:1158–1166.
Padula CA, Yeaw E. Inspiratory muscle training: integrative review of use in conditions other than COPD. Res Theory Nurs Pract 2007;21:98–118.
Enright SJ, Unnithan VB. Effect of inspiratory muscle training intensities on pulmonary function and work capacity in people who are healthy: a randomized controlled trial. Phys Ther 2011;91:894–905.
Manzano RM, Carvalho CR, Saraiva-Romanholo BM, Vieira JE. Chest physiotherapy during immediate postoperative period among patients undergoing upper abdominal surgery: randomized clinical trial. Sao Paulo Med J 2008;126:269–273.
McConnell AK. Inspiratory muscle training for managing breathlessness. Nurs Pract 2005;60–64.
Hautmann H, Hefele S, Schotten K, Huber RM. Maximal inspiratory mouth pressures (PIMAX) in healthy subjects - what is the lower limit of normal?. Respir Med 2000;94:689–693.
Dimitriadis Z, Kapreli E, Konstantinidou I, Oldham J, Strimpakos N. Test/ retest reliability of maximum mouth pressure measurements with the MicroRPM in healthy volunteers. Respir Care 2011;56:776–782.
Kulkarni SR, Fletcher E, McConnell AK, Poskitt KR, Whyman MR. Pre-operative inspiratory muscle training preserves postoperative inspiratory muscle strength following major abdominal surgery - a randomised pilot study. Ann R Coll Surg Engl 2010;92:700–705.
Greenfield S, Nelson EC. Recent developments and future issues in the use of health status assessment measures in clinical settings. Med Care 1992;30(Suppl):MS23–MS41.
Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA 1995;273:59–65.
WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med 1998b;28:551–558.
Welkowitz J, Ewen RB, Cohen J. Introductory statistics for the behavioral sciences. 3rd ed. San Diego, CA: Harcourt Brace Jovanovich; 1982.
Pehlivan E, Turna A, Gurses A, Gurses HN. The effects of preoperative short-term intense physical therapy in lung cancer patients: a randomized controlled trial. Ann Thorac Cardiovasc Surg 2011;17:461–468.
Savci S, Degirmenci B, Saglam M, Arikan H, Inal-Ince D, Turan HN, Demircin M. Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: a randomized controlled trial. Scand Cardiovasc J 2011;45:286–293.
Moodie L, Reeve J, Elkins M. Inspiratory muscle training increases inspiratory muscle strength in patients weaning from mechanical ventilation: a systematic review. J Physiother 2011;57:213–221.
Makoto S, Hajime K, Masahiro K. Effect of inspiratory and expiratory muscle training in normal subjects. J Phys Assoc 2005;8:029–037.
Weiner P, Azgad Y, Weiner M. Inspiratory muscle training during treatment with corticosteroids in humans. Chest 1995;107:1041–1044.
Félix E, Gimenes AC, Costa-Carvalho BT. Effects of inspiratory muscle training on lung volumes, respiratory muscle strength, and quality of life in patients with ataxia telangiectasia. Pediatr Pulmonol 2014;49:238–244.
Ysayama L, Lopes L, Silva A, Reollo N. The influence of the respiratory muscular training in the recovery of esophagectomy. ABCD Arq Bras Cir Dig 2008;21:61–64.
Edwards AM, Cooke CB. Oxygen uptake kinetics and maximal aerobic power are unaffected by inspiratory muscle training in healthy subjects where time to exhaustion is extended. Eur J Appl Physiol 2004;93:139–144.
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.
About this article
Cite this article
Mohamady, H.M., Waked, I.S. & Attalla, A.F. Preoperative respiratory physical therapy program as a prehabilitation to improve inspiratory muscle function and quality of life in patients undergoing upper abdominal surgeries: a prospective randomized controlled trial. Bull Fac Phys Ther 21, 17–22 (2016). https://doi.org/10.4103/1110-6611.188030
- upper abdominal surgeries