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Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: a randomized controlled trial
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark .ORCID iD: 0000-0001-7085-6507
Aalborg University, Aalborg, Denmark.
KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium.
Faculty of Medicine and Health, Surgery, Örebro University, Örebro, Sweden.
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2016 (English)In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 49, no 5, 1483-1491 p., 26489835Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES The aim was to investigate whether 2 weeks of inspiratory muscle training (IMT) could preserve respiratory muscle strength in high-risk patients referred for pulmonary resection on the suspicion of or confirmed lung cancer. Secondarily, we investigated the effect of the intervention on the incidence of postoperative pulmonary complications.

METHODS The study was a single-centre, parallel-group, randomized trial with assessor blinding and intention-to-treat analysis. The intervention group (IG, n = 34) underwent 2 weeks of postoperative IMT twice daily with 2 × 30 breaths on a target intensity of 30% of maximal inspiratory pressure, in addition to standard postoperative physiotherapy. Standard physiotherapy in the control group (CG, n = 34) consisted of breathing exercises, coughing techniques and early mobilization. We measured respiratory muscle strength (maximal inspiratory/expiratory pressure, MIP/MEP), functional performance (6-min walk test), spirometry and peripheral oxygen saturation (SpO2), assessed the day before surgery and again 3–5 days and 2 weeks postoperatively. Postoperative pulmonary complications were evaluated 2 weeks after surgery.

RESULTS The mean age was 70 ± 8 years and 57.5% were males. Thoracotomy was performed in 48.5% (n = 33) of cases. No effect of the intervention was found regarding MIP, MEP, lung volumes or functional performance at any time point. The overall incidence of pneumonia was 13% (n = 9), with no significant difference between groups [IG 6% (n = 2), CG 21% (n = 7), P = 0.14]. An improved SpO2 was found in the IG on the third and fourth postoperative days (Day 3: IG 93.8 ± 3.4 vs CG 91.9 ± 4.1%, P = 0.058; Day 4: IG 93.5 ± 3.5 vs CG 91 ± 3.9%, P = 0.02). We found no association between surgical procedure (thoracotomy versus thoracoscopy) and respiratory muscle strength, which was recovered in both groups 2 weeks after surgery.

CONCLUSIONS Two weeks of additional postoperative IMT, compared with standard physiotherapy alone, did not preserve respiratory muscle strength but improved oxygenation in high-risk patients after lung cancer surgery. Respiratory muscle strength recovered in both groups 2 weeks after surgery.

Place, publisher, year, edition, pages
Oxford University Press, 2016. Vol. 49, no 5, 1483-1491 p., 26489835
Keyword [en]
Inspiratory muscle training; lung cancer; surgery; pulmonary complications, postoperative; physiotherapy
National Category
Medical and Health Sciences Surgery Physiotherapy
Research subject
Surgery esp. Thoracic and Cardivascular Surgery
Identifiers
URN: urn:nbn:se:oru:diva-46375DOI: 10.1093/ejcts/ezv359OAI: oai:DiVA.org:oru-46375DiVA: diva2:866315
Available from: 2015-11-02 Created: 2015-11-02 Last updated: 2017-06-14Bibliographically approved
In thesis
1. Physiotherapy interventions and outcomes following lung cancer surgery
Open this publication in new window or tab >>Physiotherapy interventions and outcomes following lung cancer surgery
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to evaluate the effect of exercise training and inspiratory muscle training and to describe pulmonary function, respiratory muscle strength, physical performance and health-related quality of life (HRQoL) following lung cancer surgery.

Study I was a randomised controlled trial including 78 patients radically operated for lung cancer. The intervention group received 10 sessions of supervised exercise training in addition to home-based exercise; the control group was instructed on home-exercise alone. Supervised compared to non-supervised exercise training did not result in differences between groups in HRQoL, except for the SF-36 bodily pain domain four months after the surgery. No effects of supervised training were found for any outcome after one year.

Study II was descriptive and was based on the study I sample. We evaluated the course of recovery of HRQoL and physical performance up to one year following surgery. All patients improved HRQoL and physical performance one year after the surgery, reaching values comparable to a reference healthy population. The walked distance was positively associated with the SF-36 domain for physical functioning.

Study III was descriptive, included 81 patients and evaluated the influence of surgery on respiratory muscle strength, lung function and physical performance two weeks and six months after surgery. We found that respiratory muscle strength was not affected after the second postoperative week and that muscle-sparring thoracotomy did not deteriorate respiratory muscle strength, compared to video-assisted thoracic surgery. Compared to preoperative values, physical performance was recovered, whereas lung function remained reduced six months postoperatively.

Study IV was a randomised controlled trial including 68 patients at high risk of developing postoperative pulmonary complications (PPC). This study evaluated the effects of two weeks of postoperative inspiratory muscle training in addition to breathing exercises and early mobilisation on respiratory muscle strength and the incidence of PPC. Additional inspiratory muscle training did not increase respiratory muscle strength, but improved postoperative oxygenation. Respiratory muscle strength was recovered in both groups two weeks postoperatively.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2015. 66 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 129
Keyword
lung cancer, surgery, quality of life, exercise, inspiratory muscle training, physical performance, pulmonary complications
National Category
Surgery Medical and Health Sciences
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-45728 (URN)978-91-7529-097-3 (ISBN)
Public defence
2015-11-23, Universitetssjukhuset, hörsal C1, Södra Grev Rosengatan, Örebro, 09:00 (English)
Opponent
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Available from: 2015-09-07 Created: 2015-09-07 Last updated: 2015-12-21Bibliographically approved

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Brocki, Barbara CristinaSouza, Domingos S. R.Westerdahl, Elisabeth
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