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  • 1.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro University, Örebro, Sweden.
    Lundholm, Ulla Persson
    Nora Health Care Centre, Örebro County Council, Nora, Sweden.
    Kohn, Monica
    Nora Health Care Centre, Örebro County Council, Nora, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro University, Örebro, Sweden.
    Medical yoga: another way of being in the world-A phenomenological study from the perspective of persons suffering from stress-related symptoms2014In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, article id 23033Article in journal (Refereed)
    Abstract [en]

    The prevalence of stress-related illness has grown in recent years. Many of these patients seek help in primary health care. Yoga can reduce stress and thus complements pharmacological therapy in medical practice. To our knowledge, no studies have investigated patients' experiences of yoga treatment in a primary health care setting or, specifically, the experiences of yoga when suffering from stress-related illness. Thus, the aim of the present study was to explore the meaning of participating in medical yoga as a complementary treatment for stress-related symptoms and diagnosis in a primary health care setting. This study has a descriptive phenomenological design and took place at a primary health care centre in Sweden during 2011. Five women and one man (43-51 years) participated. They were recruited from the intervention group (n = 18) in a randomized control trial, in which they had participated in a medical yoga group in addition to standard care for 12 weeks. Data were collected by means of qualitative interviews, and a phenomenological data analysis was conducted. The essential meaning of the medical yoga experience was that the medical yoga was not an endpoint of recovery but the start of a process towards an increased sense of wholeness. It was described as a way of alleviating suffering, and it provided the participants with a tool for dealing with their stress and current situation on a practical level. It led to greater self-awareness and self-esteem, which in turn had an implicit impact on their lifeworld. In phenomenological terms, this can be summarized as Another way of being in the world, encompassing a perception of deepened identity. From a philosophical perspective, due to using the body in a new way (yoga), the participants had learnt to see things differently, which enriched and recast their perception of themselves and their lives.

  • 2.
    Annika, Lindh
    et al.
    Örebro University, School of Health Sciences.
    Theander, K.
    Arne, M.
    Lisspers, K.
    Lundh, L.
    Sandelowsky, H.
    Ställberg, B.
    Thors Adolfsson, E.
    Westerdahl, Elisabeth
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Zakrisson, Ann-Britt
    Örebro University, School of Health Sciences. Örebro University Hospital.
    A descriptive study of incorrect inhalation technique in patients with COPD in primary care2018Conference paper (Refereed)
  • 3.
    Brocki, Barbara Cristina
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark .
    Andreasen, Jan Jesper
    Aalborg University, Aalborg, Denmark.
    Langer, Daniel
    Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
    Souza, Domingos S. R.
    Faculty of Medicine and Health, Surgery, Örebro University, Örebro, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    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 trial2016In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 49, no 5, p. 1483-1491, article id 26489835Article in journal (Refereed)
    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.

  • 4.
    Brocki, Barbara Cristina
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark.
    Andreasen, Jane
    Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark.
    Nielsen, Lene Rodkjaer
    Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark.
    Nekrasas, Vytautas
    Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark.
    Gorst- Rasmussen, Anders
    Centre for Cardiovascular Research, Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden.
    Short and long-term effects of supervised versus unsupervised exercise training on health-related quality of life and functional outcomes following lung cancer surgery: a randomized controlled trial2014In: Lung Cancer, ISSN 0169-5002, E-ISSN 1872-8332, Vol. 83, no 1, p. 102-108Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    Surgical resection enhances long-term survival after lung cancer, but survivors face functional deficits and report on poor quality of life long time after surgery. This study evaluated short and long-term effects of supervised group exercise training on health-related quality of life and physical performance in patients, who were radically operated for lung cancer.

    METHODS:

    A randomized, assessor-blinded, controlled trial was performed on 78 patients undergoing lung cancer surgery. The intervention group (IG, n=41) participated in supervised out-patient exercise training sessions, one hour once a week for ten weeks. The sessions were based on aerobic exercises with target intensity of 60-80% of work capacity, resistance training and dyspnoea management. The control group (CG, n=37) received one individual instruction in exercise training. Measurements consisted of: health-related quality of life (SF36), six minute walk test (6MWT) and lung function (spirometry), assessed three weeks after surgery and after four and twelve months.

    RESULTS:

    Both groups were comparable at baseline on demographic characteristic and outcome values. We found a statistically significant effect after four months in the bodily pain domain of SF36, with an estimated mean difference (EMD) of 15.3 (95% CI:4 to 26.6, p=0.01) and a trend in favour of the intervention for role physical functioning (EMD 12.04, 95% CI: -1 to 25.1, p=0.07) and physical component summary (EMD 3.76, 95% CI:-0.1 to 7.6, p=0.06). At 12 months, the tendency was reversed, with the CG presenting overall slightly better measures. We found no effect of the intervention on 6MWT or lung volumes at any time-point.

    CONCLUSION:

    Supervised compared to unsupervised exercise training resulted in no improvement in health-related quality of life, except for the bodily pain domain, four months after lung cancer surgery. No effects of the intervention were found for any outcome after one year.

  • 5.
    Brocki, Barbara Cristina
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Andreasen, Jan Jesper
    Department of Cardiothoracic surgery and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
    Souza, Domingos S. R.
    Faculty of Medicine and Health, Surgery, Örebro University, Örebro, Sweden .
    Improvements in physical performance and health-related quality of life one year after radical operation for lung cancer2015In: Cancer Treatment Communications, ISSN 2213-0896, Vol. 4, p. 65-74Article in journal (Refereed)
    Abstract [en]

    Micro abstract: This study assessed physical performance and health-related quality of life one year after lung cancer surgery and investigated the potential association between both outcomes. We found that the walked distance was associated with the subjective perception of the physical functioning. Patients improved health-related quality of life, reaching values similar to a healthy reference population.

    Background: Resuming an acceptable level of lifestyle and health-related quality of life after lung cancer surgery has become an important issue. We aimed to evaluate the course of recovery of physical performance and health-related quality of life following pulmonary resection for lung cancer, as well as examine the potential association between these outcomes.

    Methods: In an observational design, we assessed 78 individuals radically operated for lungcancer. We measured health-related quality of life (SF-36), six-minute walk test (6MWT) and lung function (spirometry)three weeks (baseline), four and twelve months after surgery. SF-36 values were compared to an age-and gender-matched reference population.

    Results: The mean age was 65 years (SD9), 59% were males. Thoracotomy was performed in 77% of the cases. Compared to baseline values, we found significant improvements after one year in SF-36 physical and mental component summary components of large effect size (0.8 and 0.9 respectively). Values for both SF-36 summary components were comparable to those of the reference population. The improvement in 6MWT was of moderate effect size (0.6). We found a positive association between 6MWT and the SF-36 domain for physical functioning (β=0.05, 95% CI [0.00;0.09], p=0.03) one year after surgery.

    Conclusion: Individuals who were radically operated for lung cancer improved health-related quality of life one year after surgery, reaching values similar to a healthy reference population. The walked distance was positively associated with the subjective perception of physical functioning. The clinical significance of these findings deserves further investigation.

  • 6.
    Brocki, Barbara Cristina
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Aalborg University Hospital, Aalborg, Denmark.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Souza, Domingos S. R.
    Department of Cardiothoracic Surgery and Anaesthesiology, Örebro University Hospital, Örebro, Sweden.
    Andreasen, Jan Jesper
    University Hospital, Aalborg, Denmark.
    Factors influencing postoperative pulmonary complications following pulmonary resection due to malignant or benign lung tumour: preliminary results2014Conference paper (Refereed)
  • 7.
    Brocki, Barbara
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg,.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Langer, Daniel
    KU Leuven Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium; Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Belgium; .
    Souza, Domingos SR
    Faculty of Medicine and Health, Surgery, Örebro University, Örebro, Sweden.
    Andreasen, Jan Jesper
    Departments of Cardiothoracic Surgery and Clinical Medicine, Aalborg University Hospital,.
    Respiratory muscle strength is not affected two weeks and six months following pulmonary resectionManuscript (preprint) (Other academic)
  • 8.
    Fagevik Olsén, Monika
    et al.
    Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Occupational and Physical Therapy, Sahlgrenska Academy, Gothenburg University, Sweden.
    Lindstrand, Hilda
    Department of Occupational and Physical Therapy, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Lind Broberg, Jenny
    Department of Occupational and Physical Therapy, Sahlgrenska Academy, Gothenburg University, Gothenburg Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Sciences, Clinical Physiology, Uppsala University Hospital, Uppsala, Sweden.
    Measuring chest expansion; a study comparing two different instructions2011In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 13, no 3, p. 128-132Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to examine and compare the effect of two alternative instructions when measuring chest expansion. In 100 healthy subjects, chest expansion was measured using a circumference tape. In 30 healthy subjects, chest expansion was measured by a Respiratory Movement Measuring Instrument (RMMI). Both measurements were made at the level of the fourth rib and the xiphoid process. The two instructions evaluated were the traditional one: “breathe in maximally” and “breathe out maximally”, which were compared with a new one “breathe in maximally and make yourself as big as possible” and “breathe out maximally and make yourself as small as possible”. The addition of “make yourself as big/small as possible” in the new instruction resulted in a significantly increased thoracic excusion, 1.4 cm in upper and 0.9 cm in lower level of thorax, measured by tape, compared with the traditional instruction (p < 0.001). Measurements obtained using the RMMI also showed a significant difference, 2.3 mm in upper and 4.1 mm in lower level of thorax, between the two instructions in favour of the new instruction (p < 0.05). The verbal instruction during measurement of chest expansion is of importance when measured by tape and RMMI. To assess the maximal range of motion in the chest, the patient should be instructed not only to “breathe in/out maximally”, but also instructed to “make yourself as big/small as possible”

  • 9.
    Fagevik Olsén, Monika
    et al.
    Department of Physiotherapy, Sahlgrenska University Hospital and Institute for Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg .
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences.
    Positive expiratory pressure in patients with chronic obstructive pulmonary disease: a systematic review2009In: Respiration, ISSN 0025-7931, E-ISSN 1423-0356, Vol. 77, no 1, p. 110-118Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Breathing exercises against a resistance during expiration are often used as treatment for patients with chronic obstructive pulmonary disease (COPD). Controversy still exists regarding the clinical application and efficacy.

    OBJECTIVES: The aim of this systematic review was to determine the effects of chest physiotherapy techniques with positive expiratory pressure (PEP) for the prevention and treatment of pulmonary impairment in adults with COPD.

    METHODS: The review was conducted on randomised, controlled clinical trials in which breathing exercises with positive expiratory pressure were compared with other chest physical therapy techniques or with no treatment, in adult patients with COPD. A computer-assisted literature search of available databases from 1970 to January 2008 was performed. Two reviewers extracted data independently and assessed the trials systematically with an instrument for measuring methodological quality.

    RESULTS: In total, 11 trials met the inclusion criteria, of which 5 reached an adequate level of internal validity. Several kinds of PEP techniques with a diversity of intensities and durations of treatment have been evaluated with different outcome measures and follow-up periods. Benefits of PEP were found in isolated outcome measures in separate studies with a follow-up period <1 month. Concerning long-term effects, the results are contradictory.

    CONCLUSION: Prior to widespread prescription of long-term PEP treatment, more research is required to establish the benefit of the technique in patients with COPD.

  • 10.
    Johansson, Henrik
    et al.
    Department of Neuroscience, Physical therapy, Uppsala University, Uppsala, Sweden.
    Sjöholm, Rebecca
    Department of Neuroscience, Physical therapy, Uppsala University, Uppsala, Sweden Sweden.
    Stafberg, Anders
    Department of Neuroscience, Physical therapy, Uppsala University, Uppsala, Sweden Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.
    Breathing exercises with positive expiratory pressure after abdominal surgery: the current physical therapy practice in Sweden2013In: Journal of Anesthesia & Clinical Research, ISSN 2155-6148, E-ISSN 2155-6148, Vol. 4, no 6, p. 325-Article in journal (Other academic)
    Abstract [en]

    Objectives: In Sweden breathing exercises with Positive Expiratory Pressure (PEP) are commonly recommended for the prevention of pulmonary complications after abdominal surgery. Scientific documentation of the effects of PEP treatment is limited. The aim of this national survey was to describe the current physical therapy practice of PEP treatment after abdominal surgery in Sweden.

    Methods: A questionnaire was sent by e-mail to the 45 physical therapists who work with abdominal surgery patients in all seven university hospitals in Sweden. The questionnaire contained questions about the usage of PEP after abdominal surgery.

    Results: In total, 24 (54%) of the physical therapists answered the questionnaire. All reported using PEP as a treatment option after abdominal surgery. The most commonly used PEP device was the Blow bottle system and the PEP ventil system connected to a mouthpiece. Recommendations regarding treatment frequency and implementation varied significantly across respondents. The number of breaths per treatment varied considerably.

    Conclusion: All respondentsreported using PEP as a postoperative treatment on abdominal surgery wards. The treatment is most often recommended hourly during the first postoperative days. The common first-choice PEP devices were the Blow bottle system, Pep/Rmt set with mouthpiece or mask, Breathing exerciser/PEP valve system 22, and the Mini-PEP.

  • 11.
    Jonsson, Marcus
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden; Department of Cardiothoracic surgery, Örebro University Hospital, Örebro, Sweden.
    Urell, Charlotte
    Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden.
    Emtner, Margareta
    Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden; Department of Cardiothoracic surgery, Örebro University Hospital, Örebro, Sweden.
    Self-reported physical activity and lung function two months after cardiac surgery: a prospective cohort study2014In: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 9, article id 59Article in journal (Refereed)
    Abstract [en]

    Background: Physical activity has well-established positive health-related effects. Sedentary behaviour has been associated with postoperative complications and mortality after cardiac surgery. Patients undergoing cardiac surgery often suffer from impaired lung function postoperatively. The association between physical activity and lung function in cardiac surgery patients has not previously been reported.

    Methods: Patients undergoing cardiac surgery were followed up two months postoperatively. Physical activity was assessed on a four-category scale (sedentary, moderate activity, moderate regular exercise, and regular activity and exercise), modified from the Swedish National Institute of Public Health's national survey. Formal lung function testing was performed preoperatively and two months postoperatively.

    Results: The sample included 283 patients (82% male). Two months after surgery, the level of physical activity had increased (p < 0.001) in the whole sample. Patients who remained active or increased their level of physical activity had significantly better recovery of lung function than patients who remained sedentary or had decreased their level of activity postoperatively in terms of vital capacity (94 +/- 11% of preoperative value vs. 91 (+/-) 9%; p = 0.03), inspiratory capacity (94 +/- 14% vs. 88 +/- 19%; p = 0.008), and total lung capacity (96 +/- 11% vs. 90 +/- 11%; p = 0.01).

    Conclusions: An increased level of physical activity, compared to preoperative level, was reported as early as two months after surgery. Our data shows that there could be a significant association between physical activity and recovery of lung function after cardiac surgery. The relationship between objectively measured physical activity and postoperative pulmonary recovery needs to be further examined to verify these results.

  • 12.
    Köhn, M.
    et al.
    Nora Health Care Centre, Örebro County Council, Nora, Sweden.
    Persson Lundholm, U.
    Nora Health Care Centre, Örebro County Council, Nora, Sweden.
    Bryngelsson, I.-L.
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Anderzén-Carlsson, Agneta
    Örebro University Hospital. Centre for Health Care Sciences.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences.
    Medical yoga for patients with stress-related symptoms and diagnosis in primary health care: a randomized control trial2013In: Evidence-based Complementary and Alternative Medicine, ISSN 1741-427X, E-ISSN 1741-4288, article id 215348Article in journal (Refereed)
    Abstract [en]

    An increasing number of patients are suffering from stress-related symptoms and diagnoses. The purpose of this study was to evaluate the medical yoga treatment in patients with stress-related symptoms and diagnoses in primary health care. A randomized controlled study was performed at a primary health care centre in Sweden from March to June, 2011. Patients were randomly allocated to a control group receiving standard care or a yoga group treated with medical yoga for 1 hour, once a week, over a 12-week period in addition to the standard care. A total of 37 men and women, mean age of years were included. General stress level (measured using Perceived Stress Scale (PSS)), burnout (Shirom-Melamed Burnout Questionnaire (SMBQ)), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), insomnia severity (Insomnia Severity Index (ISI)), pain (visual analogue scale (VAS)), and overall health status (Euro Quality of Life VAS (EQ-VAS)) were measured before and after 12 weeks. Patients assigned to the Yoga group showed significantly greater improvements on measures of general stress level ( ), anxiety ( ), and overall health status ( ) compared to controls. Treatment with medical yoga is effective in reducing levels of stress and anxiety in patients with stress-related symptoms in primary health care.

  • 13.
    Lomi, Constantina
    et al.
    Department of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden .
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Physical therapy treatment after cardiac surgery: a national survey of practice in Greece2013In: Journal of Clinical & Experimental Cardiology, ISSN 2155-9880, no S7, p. 004-Article in journal (Other academic)
    Abstract [en]

    Physical therapy is offered to patients undergoing cardiac surgery in many countries. There is limited published data on what physical therapy treatments are provided and what exercises are recommended to patients after cardiac surgery in Europe. The aim of this survey was to establish the current practice of physical therapy for cardiac surgery patients in Greece. A prospective survey was carried out among a total population sample of physical therapists at all public and private cardiothoracic centers in Greece. A postal questionnaire was used to determine the actual physical therapy management of cardiac surgery patients. In total, 45 physical therapists (response rate 78%) from public and private hospitals completed the survey. The mean work experience as physical therapist at a department of cardiothoracic surgery was 10 ± 6 years. Preoperative information was given, according to half of the physical therapists. During the first postoperative days the patients usually received 1 to 6 treatment sessions a day by the physical therapist. Usual physical therapy treatments during the first postoperative days were breathing exercises, coughing techniques, chest wall vibrations, and mobilization. Coughing support was provided to the patients, according to 91% of the physical therapists. Manual coughing support from the physical therapist was the most common technique. In total, 93% of the physical therapists instructed the patients to perform breathing exercises on a regular basis postoperatively. Deep breathing exercises and incentive spirometry were the two most frequently used techniques. Recommendations to continue the breathing exercises for a period of between 3 days and 8 months were given postoperatively. This survey provides an initial insight into physical therapy practice for cardiac surgery patients in Greece. Further comparison between countries is warranted to improve the management of the cardiac surgery patient.

  • 14.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Ctr Hlth Care Sci, Örebro Univ Hosp, Örebro, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Wittrin, A.
    Gunnarsson, Martin
    Örebro University, School of Medicine, Örebro University, Sweden.
    Correlation between maximal walking distance and self-rated limitations in walking2014In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 20, no 7, p. 992-992Article in journal (Other academic)
  • 15.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Wittrin, Anna
    Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Gunnarsson, Martin
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Walking Distance as a Predictor of Falls in People With Multiple Sclerosis2016In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 21, no 2, p. 102-108Article in journal (Refereed)
    Abstract [en]

    Background and purpose: People with multiple sclerosis (PwMS) experience falls, usually when walking and transferring. The aim was to investigate if walking distance and patient overestimate of walking distance are predictors of falls in PwMS.

    Methods: A prospective study was conducted, with a single test occasion followed by prospective registration of falls for 3 months. All PwMS in Region Örebro County with a previously registered Expanded Disability Status Scale score between 3.0 and 7.0 in the Swedish MS Registry were invited to participate (n = 149). Altogether, data from 49 PwMS being relapse free for at least 3 months and with a confirmed Expanded Disability Status Scale between 1.5 and 7.0 upon study entry were analysed.

    Results: Twenty-two PwMS (45%) fell during the study period, providing information of 66 falls. Walking distance or overestimate of one's walking distance, as compared with test results, did not predict falls in this MS sample.

    Discussion: Walking and standing activities are associated with numerous falls in PwMS. Our data do not clearly support routine measurements of walking distance in assessing individual fall risk.

  • 16.
    Olsen, Monika Fagevik
    et al.
    Department of Gastrosurgical Research and Education, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Physical Therapy, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Carlsson, Maria
    Department of Physical Therapy, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Olsen, Erik
    Chalmers University of Technology, Gothenburg, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.
    Evaluation of Pressure Generated by Resistors From Different Positive Expiratory Pressure Devices2015In: Respiratory care, ISSN 0020-1324, E-ISSN 1943-3654, Vol. 60, no 10, p. 1418-1423Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Breathing exercises with positive expiratory pressure (PEP) are used to improve pulmonary function and airway clearance. Different PEP devices are available, but there have been no studies that describe the pressure generated by different resistors. The purpose of this study was to compare pressures generated from the proprietary resistor components of 4 commercial flow-dependent PEP valves with all other parameters kept constant.

    METHODS: Resistors from 4 flow-regulated PEP devices (Pep/Rmt system, Wellspect HealthCare; Pipe P breathing exerciser, Koo Medical Equipment; Mini-PEP, Philips Respironics [including resistors by Rusch]; and 15-mm endo-adapter, VBM Medizintechnik) were tested randomly by a blinded tester at constant flows of 10 and 18 L/min from an external gas system. All resistors were tested 3 times.

    RESULTS: Resistors with a similar diameter produced statistically significant different pressures at the same flow. The differences were smaller when the flow was 10 L/min compared with 18 L/min. The differences were also smaller when the diameter of the resistor was increased. The pressures produced by the 4 resistors of the same size were all significantly different when measuring 1.5- and 2.0-mm resistors at a flow of 10 L/min and 2.0-mm resistors at a flow of 18 L/min (P < .001). There were no significant differences between any of the resistors when testing sizes of 4.5 and 5.0 mm at either flow. The Mini-PEP and adapter resistors gave the highest pressures.

    CONCLUSIONS: Pressures generated by the different proprietary resistor components of 4 commercial PEP devices were not comparable, even though the diameter of the resistors is reported to be the same. The pressures generated were significantly different, particularly when using small-diameter resistors at a high flow. Therefore, the resistors may not be interchangeable. This is important information for clinicians, particularly when considering PEP for patients who do not tolerate higher pressures. (C) 2015 Daedalus Enterprises

  • 17.
    Olsen, Monika Fagevik
    et al.
    Department of Physical Therapy and Occupational Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Physical Therapy, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Gastrosurgical Research & Education, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden .
    Lannefors, Louise
    Cystic Fibrosis Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.
    Positive expiratory pressure: common clinical applications and physiological effects2015In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 109, no 3, p. 297-307Article, review/survey (Refereed)
    Abstract [en]

    Breathing out against resistance, in order to achieve positive expiratory pressure (PEP), is applied by many patient groups. Pursed lips breathing and a variety of devices can be used to create the resistance giving the increased expiratory pressure. Effects on pulmonary outcomes have been discussed in several publications, but the expected underlying physiology of the effect is seldom discussed.

    The aim of this article is to describe the purpose, performance, clinical application and underlying physiology of PEP when it is used to increase lung volumes, decrease hyperinflation or improve airway clearance.

    In clinical practice, the instruction how to use an expiratory resistance is of major importance since it varies. Different breathing patterns during PEP increase or reduce expiratory flow, result in movement of EPP centrally or peripherally and can increase or decrease lung volume. It is therefore necessary to give the right instructions to obtain the desired effects. As the different PEP techniques are being used by diverse patient groups it is not possible to give standard instructions. Based on the information given in this article the instructions have to be adjusted to give the optimal effect. There is no consensus regarding optimal treatment frequency and number of cycles included in each treatment session and must also be individualized.

    In future research, more precise descriptions are needed about physiological aims and specific instructions of how the treatments have been performed to assure as good treatment quality as possible and to be able to evaluate and compare treatment effects. (c) 2014 Elsevier Ltd. All rights reserved.

  • 18.
    Pettersson, Henrik
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Sweden; Department of Physiotherapy, Karolinska University Hospital, Solna, Sweden.
    Faager, Gun
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Sweden; Department of Physiotherapy, Karolinska University Hospital, Solna, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Improved oxygenation during standing performance of deep breathing exercises with positive expiratory pressure after cardiac surgery: a randomized controlled trial2015In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, no 8, p. 748-752Article in journal (Refereed)
    Abstract [en]

    Objective: Breathing exercises after cardiac surgery are often performed in a sitting position. It is unknown whether oxygenation would be better in the standing position. The aim of this study was to evaluate oxygenation and subjecfive breathing ability during sitting vs standing performance of deep breathing exercises on the second day after cardiac surgery.

    Methods: Patients undergoing coronary artery bypass grafting (n=189) were randomized to sitting (controls) or standing. Both groups performed 3 x 10 deep breaths with a positive expiratory pressure device. Peripheral oxygen saturation was measured before, directly after, and 15 min after the intervention. Subjective breathing ability, blood pressure, heart rate, and pain were assessed.

    Results: Oxygenation improved significantly in the standing group compared with controls directly after the breathing exercises (p <0.001) and after 15 min rest (p=0.027). The standing group reported better deep breathing ability compared with controls (p=0.004). A slightly increased heart rate was found in the standing group (p= 0.047).

    Conclusion: After cardiac surgery, breathing exercises with positive expiratory pressure, performed in a standing position, significantly improved oxygenation and subjective breathing ability compared with sitting performance. Performance of breathing exercises in the standing position is feasible and could be a valuable treatment for patients with postoperative hypoxaemia.

  • 19. Urell, Charlotte
    et al.
    Emtner, Margareta
    Hedenstrom, Hans
    Tenling, Arne
    Breidenskog, Marie
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences.
    Deep breathing exercises with positive expiratory pressure at a higher rate improve oxygenation in the early period after cardiac surgery: a randomised controlled trial2011In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 40, no 1, p. 162-167Article in journal (Refereed)
    Abstract [en]

    Objective: In addition to early mobilisation, a variety of breathing exercises are used to prevent postoperative pulmonary complications after cardiac surgery. The optimal duration of the treatment is not well evaluated. The aim of this study was to determine the effect of 30 versus 10 deep breaths hourly, while awake, with positive expiratory pressure on oxygenation and pulmonary function the first days after cardiac surgery. Methods: A total of 181 patients, undergoing cardiac surgery, were randomised into a treatment group, performing 30 deep breaths hourly the first postoperative days, or into a control group performing 10 deep breaths hourly. The main outcome measurement arterial blood gases and the secondary outcome pulmonary function, evaluated with spirometry, were determined on the second postoperative day. Results: Preoperatively, both study groups were similar in terms of age, SpO(2), forced expiratory volume in 1 s and New York Heart Association classification. On the second postoperative day, arterial oxygen tension (PaO(2)) was 8.9 +/- 1.7 kPa in the treatment group and 8.1 +/- 1.4 kPa in the control group (p = 0.004). Arterial oxygen saturation (SaO(2)) was 92.7 +/- 3.7% in the treatment group and 91.1 +/- 3.8% in the control group (p = 0.016). There were no differences in measured lung function between the groups or in compliance to the breathing exercises. Compliance was 65% of possible breathing sessions. Conclusions: A significantly increased oxygenation was found in patients performing 30 deep breaths the first two postoperative days compared with control patients performing 10 deep breaths hourly. These results support the implementation of a higher rate of deep breathing exercises in the initial phase after cardiac surgery. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B. V. All rights reserved.

  • 20.
    Urell, Charlotte
    et al.
    Department of Neuroscience: Physiotherapy, Uppsala University, Uppsala, Sweden.
    Emtner, Margareta
    Department of Neuroscience: Physiotherapy, Uppsala University, Uppsala, Sweden; Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden.
    Hedenström, Hans
    Department of Medical Sciences: Clinical Physiology, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health Sciences. Department of Medical Sciences: Clinical Physiology, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden; UFC, Region Örebro County, Örebro, Sweden.
    Respiratory muscle strength is not decreased in patients undergoing cardiac surgery2016In: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 11, article id 41Article in journal (Refereed)
    Abstract [en]

    Background: Postoperative pulmonary impairments are significant complications after cardiac surgery. Decreased respiratory muscle strength could be one reason for impaired lung function in the postoperative period. The primary aim of this study was to describe respiratory muscle strength before and two months after cardiac surgery. A secondary aim was to describe possible associations between respiratory muscle strength and lung function.

    Methods: In this prospective observational study 36 adult cardiac surgery patients (67 ± 10 years) were studied. Respiratory muscle strength and lung function were measured before and two months after surgery.

    Results: Pre- and postoperative respiratory muscle strength was in accordance with predicted values; MIP was 78 ± 24 cmH2O preoperatively and 73 ± 22 cmH2O at two months follow-up (p = 0.19). MEP was 122 ± 33 cmH2O preoperatively and 115 ± 38 cmH2O at two months follow-up (p = 0.18). Preoperative lung function was in accordance with predicted values, but was significantly decreased postoperatively. At two-months follow-up there was a moderate correlation between MIP and FEV1 (r = 0.43, p = 0.009).

    Conclusions: Respiratory muscle strength was not impaired, either before or two months after cardiac surgery. The reason for postoperative lung function alteration is not yet known. Interventions aimed at restore an optimal postoperative lung function should focus on other interventions then respiratory muscle strength training.

  • 21.
    Urell, Charlotte
    et al.
    Physiotherapy, Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Physiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Hedenström, Hans
    Clinical Physiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Respiratory Medicine and Allergology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Emtner, Margareta
    Respiratory Medicine and Allergology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Physiotherapy, Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Lung function before and two days after open-heart surgery2012In: Critical Care Research and Practice, ISSN 2090-1305, E-ISSN 2090-1313, Vol. 2012, article id 291628Article in journal (Refereed)
    Abstract [en]

    Reduced lung volumes and atelectasis are common after open-heart surgery, and pronounced restrictive lung volume impairment has been found. The aim of this study was to investigate factors influencing lung volumes on the second postoperative day. Open-heart surgery patients (n = 107, 68 yrs, 80% male) performed spirometry both before surgery and on the second postoperative day. The factors influencing postoperative lung volumes and decrease in lung volumes were investigated with univariate and multivariate analyses. Associations between pain (measured by numeric rating scale) and decrease in postoperative lung volumes were calculated with Spearman rank correlation test. Lung volumes decreased by 50% and were less than 40% of the predictive values postoperatively. Patients with BMI >25 had lower postoperative inspiratory capacity (IC) (33 ± 14% pred.) than normal-weight patients (39 ± 15% pred.), (P = 0.04). More pain during mobilisation was associated with higher decreases in postoperative lung volumes (VC: r = 0.33, P = 0.001; FEV(1): r = 0.35, P ≤ 0.0001; IC: r = 0.25, P = 0.01). Patients with high BMI are a risk group for decreased postoperative lung volumes and should therefore receive extra attention during postoperative care. As pain is related to a larger decrease in postoperative lung volumes, optimal pain relief for the patients should be identified.

  • 22.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Optimal technique for deep breathing exercises after cardiac surgery2015In: Minerva anestesiologica, ISSN 1827-1596, Vol. 81, no 6, p. 678-683Article in journal (Refereed)
    Abstract [en]

    Cardiac surgery patients often develop a restrictive pulmonary impairment and gas exchange abnormalities in the early postoperative period. Chest physiotherapy is routinely prescribed in order to reduce or prevent these complications. Besides early mobilization, positioning and shoulder girdle exercises, various breathing exercises have been implemented as a major component of postoperative care. A variety of deep breathing manoeuvres are recommended to the spontaneously breathing patient to reduce atelectasis and to improve lung function in the early postoperative period. Different breathing exercises are recommended in different parts of the world, and there is no consensus about the most effective breathing technique after cardiac surgery. Arbitrary instructions are given, and recommendations on performance and duration vary between hospitals. Deep breathing exercises are a major part of this therapy, but scientific evidence for the efficacy has been lacking until recently, and there is a lack of trials describing how postoperative breathing exercises actually should be performed.

    The purpose of this review is to provide a brief overview of postoperative breathing exercises for patients undergoing cardiac surgery via sternotomy, and to discuss and suggest an optimal technique for the performance of deep breathing exercises.

  • 23.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Physical therapy research in professional clinical practice2013In: Journal of Novel Physiotherapies, ISSN 2165-7025, no 3, p. 159-Article in journal (Other academic)
    Abstract [en]

    Movement and manual methods have always been the core of physical therapy practice. Since physical therapy is basically practical, this evokes the question of how well the field fits in with the scientific culture of higher education. The knowledge base of physical therapy should be based on science, supported in practice, and further methodically developed. The physical therapy performed within the health care system is shaped both by the professional community and by research findings. The aim of this study was to give a view on science in physical therapy professional practice and present aspects of difficulties to transfer research knowledge into clinical practice. Clinical practical skills and theoretical knowledge are both necessary components of physical therapy treatment. Physical therapists agree on the importance of research. Bringing science closer to clinical practice is required for the development of the physical therapy profession. However, there are barriers to incorporating research evidence into clinical practice, including lack of time and skills in searching for, and evaluating, research literature. This requires that the content of the educational programs is relevant and that sufficient time, understanding, and education are provided in clinical settings. The scientific basis in professional practice could further be strengthened through enhanced scientific skills and more easily accessible presentation of the research results. As yin and yang, research and professional practice should inter-relate to one another in a dynamic system and give rise to each other as an indivisible whole. 

  • 24.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health Sciences.
    Jonsson, Marcus
    Örebro University, School of Medical Sciences.
    Emtner, Margareta
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden.
    Pulmonary function and health-related quality of life 1-year follow up after cardiac surgery2016In: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 11, no 1, article id 99Article in journal (Refereed)
    Abstract [en]

    Background: Pulmonary function is severely reduced in the early period after cardiac surgery, and impairments have been described up to 4-6 months after surgery. Evaluation of pulmonary function in a longer perspective is lacking. In this prospective study pulmonary function and health-related quality of life were investigated 1 year after cardiac surgery.

    Methods: Pulmonary function measurements, health-related quality of life (SF-36), dyspnoea, subjective breathing and coughing ability and pain were evaluated before and 1 year after surgery in 150 patients undergoing coronary artery bypass grafting, valve surgery or combined surgery.

    Results: One year after surgery the forced vital capacity and forced expiratory volume in 1 s were significantly decreased (by 4-5 %) compared to preoperative values (p < 0.05). Saturation of peripheral oxygen was unchanged 1 year postoperatively compared to baseline. A significantly improved health-related quality of life was found 1 year after surgery, with improvements in all eight aspects of SF-36 (p < 0.001). Sternotomy-related pain was low 1 year postoperatively at rest (median 0 [min-max; 0-7]), while taking a deep breath (0 [0-4]) and while coughing (0 [0-8]). A more pronounced decrease in pulmonary function was associated with dyspnoea limitations and impaired subjective breathing and coughing ability.

    Conclusions: One year after cardiac surgery static and dynamic lung function measurements were slightly decreased, while health-related quality of life was improved in comparison to preoperative values. Measured levels of pain were low and saturation of peripheral oxygen was same as preoperatively.

  • 25.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala; Department of Physiotherapy and Thoracic Surgery, Örebro University Hospital, Örebro.
    Lindmark, B
    Department of Neuroscience, Section of Physiotherapy, University Hospital, Uppsala, Sweden .
    Bryngelsson, I
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro,Sweden.
    Tenling, A
    Department of Thoracic Anaesthesia, Huddinge Hospital, Huddinge, Sweden.
    Pulmonary function 4 months after coronary artery bypass graft surgery2003In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 97, no 4, p. 317-322Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to describe the pulmonary function and pain 4 months after coronary artery bypass graft surgery. Twenty-five male patients performed pulmonary function tests before surgery, on the 4th postoperative day and 4 months after surgery. A severe reduction in pulmonary function was present after surgery. Four months postoperatively, the patients still showed a significant decrease (6-13% of preoperative values) in vital capacity (P<0.001), inspiratory capacity (P<0.001), forced expiratory volume in 1 s (P<0.001) peak expiratory flow rate (P<0.001), functional residual capacity (P=0.05) total lung capacity (P<0.001) and single-breath carbon monoxide diffusing capacity (P<0.01). Residual volume and single-breath carbon monoxide diffusing capacity per litre of alveolar volume had returned to the preoperative level. Four months postoperatively, the median values for sternotomy pain while taking a deep breath was 0.2 and while coughing 0.3 on a 10 cm visual analogue pain scale. In conclusion, a significant restrictive pulmonary impairment persisting up to 4 months into the postoperative period was found after CABG. Measured levels of pain were low and could not explain the impairment.

  • 26.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy, Örebro Medical Centre Hospital, Örebro, Sweden .
    Lindmark, Birgitta
    Department of Neuroscience, Section of Physiotherapy, University Hospital, Uppsala, Sweden .
    Almgren, Stig-Olof
    Department of Thoracic Surgery, Örebro Medical Centre Hospital, Örebro, Sweden .
    Tenling, Arne
    Department of Thoracic Anaesthesia and Clinical Psychology, Section of Physiotherapy, University Hospital, Uppsala, Sweden .
    Chest physiotherapy after coronary artery bypass graft surgery: a comparison of three different deep breathing techniques2001In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 33, no 2, p. 79-84Article in journal (Refereed)
    Abstract [en]

    The effectiveness of three deep breathing techniques was evaluated in 98 male patients after coronary artery bypass graft surgery in a randomized trial. The techniques examined were deep breathing with a blow bottle-device, an inspiratory resistance-positive expiratory pressure mask (IR-PEP) and performed with no mechanical device. Pulmonary function and roentgenological changes were evaluated. Four days post-operatively there were significantly decreased vital capacity, inspiratory capacity, forced expiratory volume in 1 second, functional residual capacity, total lung capacity and single-breath carbon monoxide diffusing capacity in all three groups (p < 0.0001). No major differences between the treatment groups were found, but the impairment in pulmonary function tended to be less marked using the blow bottle technique. The Blow bottle group had significantly less reduction in total lung capacity (p = 0.01) compared to the Deep breathing group, while the IR-PEP group did not significantly differ from the other two groups.

  • 27.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala.
    Lindmark, Birgitta
    Department of Neuroscience, Section of Physiotherapy, University Hospital, Uppsala.
    Eriksson, Tomas
    Department of Radiology, Örebro University Hospital, Örebro.
    Friberg, Örjan
    Department of Cardiothoracic Surgery, Örebro University Hospital, Örebro.
    Hedenstierna, Göran
    Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala.
    Tenling, Arne
    Department of Cardiothoracic Anesthesia, Karolinska University Hospital, Huddinge, Sweden.
    Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery.2005In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 128, no 5, p. 3482-3488Article in journal (Refereed)
    Abstract [en]

    STUDY OBJECTIVES: To investigate the effects of deep-breathing exercises on pulmonary function, atelectasis, and arterial blood gas levels after coronary artery bypass graft (CABG) surgery.

    DESIGN, SETTING, AND PATIENTS: In a prospective, randomized trial, patients performing deep-breathing exercises (n = 48) were compared to a control group (n = 42) who performed no breathing exercises postoperatively. Patient management was similar in the groups in terms of assessment, positioning, and mobility.

    INTERVENTIONS: The patients in the deep-breathing group were instructed to perform breathing exercises hourly during daytime for the first 4 postoperative days. The exercises consisted of 30 slow, deep breaths performed with a positive expiratory pressure blow-bottle device (+ 10 cm H(2)O).

    MEASUREMENTS AND RESULTS: Spirometric measurements, spiral CT (three transverse levels), arterial blood gas analysis, and scoring of subjective experience of the breathing exercises were performed on the fourth postoperative day. Atelectasis was only half the size in the deep-breathing group compared to the control group, amounting to 2.6 +/- 2.2% vs 4.7 +/- 5.7% (p = 0.045) at the basal level and 0.1 +/- 0.2% vs 0.3 +/- 0.5% (mean +/- SD) [p = 0.01] at the apical level. Compared to the control subjects, the patients in the deep-breathing group had a significantly smaller reduction in FVC (to 71 +/- 12%, vs 64 +/- 13% of the preoperative values; p = 0.01) and FEV(1) (to 71 +/- 11%, vs 65 +/- 13% of the preoperative values; p = 0.01). Arterial oxygen tension, carbon dioxide tension, fever, or length of ICU or hospital stay did not differ between the groups. In the deep-breathing group, 72% of the patients experienced a subjective benefit from the exercises.

    CONCLUSIONS: Patients performing deep-breathing exercises after CABG surgery had significantly smaller atelectatic areas and better pulmonary function on the fourth postoperative day compared to a control group performing no exercises.

  • 28.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala; Departments of Physiotherapy and Thoracic Surgery, Örebro University Hospital, Örebro,.
    Lindmark, Birgitta
    Department of Neuroscience, Section of Physiotherapy, University Hospital, Uppsala.
    Eriksson, Tomas
    Department of Radiology, Örebro University Hospital, Örebro.
    Hedenstierna, Göran
    Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala.
    Tenling, Arne
    Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala; Department of Thoracic Anaesthesia, Huddinge University Hospital, Huddinge, Sweden.
    The immediate effects of deep breathing exercises on atelectasis and oxygenation after cardiac surgery2003In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 37, no 6, p. 363-367Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the effects of deep breathing performed on the second postoperative day after coronary artery bypass graft surgery.

    Design: The immediate effects of 30 deep breaths performed without a mechanical device (n = 21), with a blow bottle device (n = 20) and with an inspiratory resistance-positive expiratory pressure mask (n = 20) were studied. Spiral computed tomography and arterial blood gas analyses were performed immediately before and after the intervention.

    Results: Deep breathing caused a significant decrease in atelectatic area from 12.3 +/- 7.3% to 10.2 +/- 6.7% (p < 0.0001) of total lung area 1 cm above the diaphragm and from 3.9 +/- 3.5% to 3.3 +/- 3.1% (p < 0.05) 5 cm above the diaphragm. No difference between the breathing techniques was found. The aerated lung area increased by 5% (p < 0.001). The PaO (2) increased by 0.2 kPa (p < 0.05), while PaCO (2) was unchanged in the three groups.

    Conclusion: A significant decrease of atelectatic area, increase in aerated lung area and a small increase in PaO (2) were found after performance of 30 deep breaths. No difference between the three breathing techniques was found.

  • 29.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital, Örebro, Sweden; Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala, Sweden .
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Örebro University Hospital, Örebro County Council, Örebro, Sweden .
    Physiotherapy-supervised mobilization and exercise following cardiac surgery: a national questionnaire survey in Sweden2010In: Journal of Cardiothoracic Surgery, ISSN 1749-8090, Vol. 5, p. 67-Article in journal (Refereed)
    Abstract [en]

    Background: Limited published data are available on how patients are mobilized and exercised during the postoperative hospital stay following cardiac surgery. The aim of this survey was to determine current practice of physiotherapy-supervised mobilization and exercise following cardiac surgery in Sweden.

    Methods: A prospective survey was carried out among physiotherapists treating adult cardiac surgery patients. A total population sample was identified and postal questionnaires were sent to the 33 physiotherapists currently working at the departments of thoracic surgery in Sweden. In total, 29 physiotherapists (response rate 88%) from eight hospitals completed the survey.

    Results: The majority (90%) of the physiotherapists offered preoperative information. The main rationale of physiotherapy treatment after cardiac surgery was to prevent and treat postoperative complications, improve pulmonary function and promote physical activity. In general, one to three treatment sessions were given by a physiotherapist on postoperative day 1 and one to two treatment sessions were given during postoperative days 2 and 3. During weekends, physiotherapy was given to a lesser degree (59% on Saturdays and 31% on Sundays to patients on postoperative day 1). No physiotherapy treatment was given in the evenings. The routine use of early mobilization and shoulder range of motion exercises was common during the first postoperative days, but the choice of exercises and duration of treatment varied. Patients were reminded to adhere to sternal precautions. There were great variations of instructions to the patients concerning weight bearing and exercises involving the sternotomy. All respondents considered physiotherapy necessary after cardiac surgery, but only half of them considered the physiotherapy treatment offered as optimal.

    Conclusions: The results of this survey show that there are small variations in physiotherapy-supervised mobilization and exercise following cardiac surgery in Sweden. However, the frequency and duration of exercises and recommendations for sternal precautions reinforced for the healing period differ between physiotherapists. This survey provides an initial insight into physiotherapy management in Sweden. Comparison with surveys in other countries is warranted to improve the physiotherapy management and postoperative recovery of the cardiac surgery patient.

  • 30.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences. Department of Cardiothoracic Surgery, Orebro University Hospital, Orebro, Sweden.
    Olsén, Monika Fagevik
    Chest physiotherapy and breathing exercises for cardiac surgery patients in Sweden: a national survey of practice2011In: Monaldi archives for chest disease / Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo, ISSN 1122-0643, Vol. 75, no 2, p. 112-119Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Various chest physiotherapy techniques are recommended after cardiac surgery around the world. There is limited published data on what breathing exercises actually are recommended to patients after surgery in Europe. The aim of this national survey was to establish the current practice of chest physiotherapy and breathing exercises for adult patients following cardiac surgery in Sweden.

    METHODS: A postal questionnaire was sent to a total population sample of 33 Swedish physiotherapists working at the departments of cardiothoracic surgery in December 2007 and January 2008.

    RESULTS: In total, 29 replies (88%) were received. Seven male and twenty two female physiotherapists completed the questionnaire. All physiotherapists instructed, on a regular basis, the cardiac surgery patients to perform post-operative breathing exercises. Positive expiratory pressure (PEP) breathing was routinely used as the first choice for treatment by 22 (83%) of the physiotherapists. Expiratory pressures used varied between 2 and 20 cm H2O. Recommended frequency and duration of the exercises varied from 4 to 30 breaths hourly during the daytime in the first post-operative days. All physiotherapists provided coughing support to the patients. Recommendations to continue breathing exercises after discharge varied from not at all up to 3 months after surgery.

    CONCLUSIONS: Breathing exercises are regularly prescribed during the initial post-operative days after cardiac surgery in Sweden. Hourly deep breathing exercises performed with or without a PEP device were reported to be first choice treatments during the hospital stay. Instructions concerning how long patients should continue the exercises after discharge varied notably.

  • 31.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Tenling, Arne
    Department of Cardiothoracic Anesthesia, Uppsala University Hospital, Uppsala, Sweden.
    Preoperative physical therapy reduces risk of postoperative atelectasis and pneumonia in people undergoing elective cardiac surgery2014In: Evidence-Based Nursing, ISSN 1367-6539, E-ISSN 1468-9618, Vol. 17, no 1, p. 13-14Article in journal (Refereed)
  • 32.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Urell, Charlotte
    Physiotherapy, Dept Neurosci, Uppsala University, Örebro, Sweden..
    Jonsson, Marcus
    Dept Physiotherapy & Cardiothorac Surg, Örebro University Hospital, Örebro, Sweden..
    Bryngelsson, Ing-Liss
    Dept Occupat & Environm Med, Örebro University Hospital, Örebro, Sweden..
    Hedenstrom, Hans
    Dept Med Sci, Uppsala University, Uppsala, Sweden..
    Emtner, Margareta
    Dept Med Sci, Uppsala University, Uppsala, Sweden..
    Home-based deep breathing exercises after cardiac surgery - A randomized controlled trial2013In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 42, no 57, article id 4678Article in journal (Other academic)
  • 33.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden; Department of Cardiothoracic Surgery, Örebro University Hospital, Örebro, Sweden; Örebro University Hospital, Centre for Health Care Sciences, Örebro, Sweden .
    Urell, Charlotte
    Physiotherapy, Department of Neuroscience, Department of Medical Sciences, Uppsala University, Uppsala, Sweden .
    Jonsson, Marcus
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden; Department of Cardiothoracic Surgery, Örebro University Hospital, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden .
    Hedenström, Hans
    Department of Clinical Physiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden .
    Emtner, Margareta
    Physiotherapy, Department of Neuroscience, Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Department of Respiratory Medicine and Allergology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden .
    Deep breathing exercises performed 2 months following cardiac surgery: a randomized controlled trial2014In: Journal of cardiopulmonary rehabilitation and prevention, ISSN 1932-7501, Vol. 34, no 1, p. 34-42Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Postoperative breathing exercises are recommended to cardiac surgery patients. Instructions concerning how long patients should continue exercises after discharge vary, and the significance of treatment needs to be determined. Our aim was to assess the effects of home-based deep breathing exercises performed with a positive expiratory pressure device for 2 months following cardiac surgery.

    METHODS: The study design was a prospective, single-blinded, parallel-group, randomized trial. Patients performing breathing exercises 2 months after cardiac surgery (n = 159) were compared with a control group (n = 154) performing no breathing exercises after discharge. The intervention consisted of 30 slow deep breaths performed with a positive expiratory pressure device (10-15 cm H2O), 5 times a day, during the first 2 months after surgery. The outcomes were lung function measurements, oxygen saturation, thoracic excursion mobility, subjective perception of breathing and pain, patient-perceived quality of recovery (40-Item Quality of Recovery score), health-related quality of life (36-Item Short Form Health Survey), and self-reported respiratory tract infection/pneumonia and antibiotic treatment.

    RESULTS: Two months postoperatively, the patients had significantly reduced lung function, with a mean decrease in forced expiratory volume in 1 second to 93 ± 12% (P< .001) of preoperative values. Oxygenation had returned to preoperative values, and 5 of 8 aspects in the 36-Item Short Form Health Survey were improved compared with preoperative values (P< .01). There were no significant differences between the groups in any of the measured outcomes.

    CONCLUSION: No significant differences in lung function, subjective perceptions, or quality of life were found between patients performing home-based deep breathing exercises and control patients 2 months after cardiac surgery.

  • 34.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Wittrin, Anna
    Faculty of Medicine and Health, Department of Neurology and Neurophysiology, Örebro University, Örebro, Sweden.
    Kånåhols, Margareta
    Faculty of Medicine and Health, Department of Neurology and Neurophysiology, Örebro University, Örebro, Sweden.
    Gunnarsson, Martin
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Department of Neurology and Neurophysiology, Örebro University Hospital, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Deep breathing exercises with positive expiratory pressure in patients with multiple sclerosis: a randomized controlled trial2016In: Clinical Respiratory Journal, ISSN 1752-6981, E-ISSN 1752-699X, Vol. 10, no 6, p. 698-706Article in journal (Refereed)
    Abstract [en]

    Introduction: Breathing exercises with positive expiratory pressure are often recommended to patients with advanced neurological deficits, but the potential benefit in multiple sclerosis (MS) patients with mild and moderate symptoms has not yet been investigated in randomized controlled trials.

    Objectives: To study the effects of 2 months of home-based breathing exercises for patients with mild to moderate MS on respiratory muscle strength, lung function, and subjective breathing and health status outcomes.

    Methods: Forty-eight patients with MS according to the revised McDonald criteria were enrolled in a randomized controlled trial. Patients performing breathing exercises (n = 23) were compared with a control group (n = 25) performing no breathing exercises. The breathing exercises were performed with a positive expiratory pressure device (10-15 cmH2 O) and consisted of 30 slow deep breaths performed twice a day for 2 months. Respiratory muscle strength (maximal inspiratory and expiratory pressure at the mouth), spirometry, oxygenation, thoracic excursion, subjective perceptions of breathing and self-reported health status were evaluated before and after the intervention period.

    Results: Following the intervention, there was a significant difference between the breathing group and the control group regarding the relative change in lung function, favoring the breathing group (vital capacity: P < 0.043; forced vital capacity: P < 0.025). There were no other significant differences between the groups.

    Conclusion: Breathing exercises may be beneficial in patients with mild to moderate stages of MS. However, the clinical significance needs to be clarified, and it remains to be seen whether a sustainable effect in delaying the development of respiratory dysfunction in MS can be obtained.

  • 35.
    Wittrin, A.
    et al.
    Örebro Univ Hosp, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gunnarsson, Martin
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro Univ Hosp, Örebro, Sweden.
    Self-assessment of walking ability in patients with multiple sclerosis and its impact on the expanded disability status scale (EDSS) score2013In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 19, no 11, p. 118-118Article in journal (Other academic)
  • 36.
    Örman, J.
    et al.
    Department of Intensive Care, Linköping University Hospital, Linköping, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences. Department of Medical Sciences, Clinical Physiology, Uppsala University Hospital, Uppsala, Sweden; Department of Physiotherapy and Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Chest physiotherapy with positive expiratory pressure breathing after abdominal and thoracic surgery: a systematic review2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 3, p. 261-267Article in journal (Refereed)
    Abstract [en]

    A variety of chest physiotherapy techniques are used following abdominal and thoracic surgery to prevent or reduce post-operative complications. Breathing techniques with a positive expiratory pressure (PEP) are used to increase airway pressure and improve pulmonary function. No systematic review of the effects of PEP in surgery patients has been performed previously. The purpose of this systematic review was to determine the effect of PEP breathing after an open upper abdominal or thoracic surgery. A literature search of randomised-controlled trials (RCT) was performed in five databases. The trials included were systematically reviewed by two independent observers and critically assessed for methodological quality. We selected six RCT evaluating the PEP technique performed with a mechanical device in spontaneously breathing adult patients after abdominal or thoracic surgery via thoracotomy. The methodological quality score varied between 4 and 6 on the Physiotherapy Evidence Database score. The studies were published between 1979 and 1993. Only one of the included trials showed any positive effects of PEP compared to other breathing techniques. Today, there is scarce scientific evidence that PEP treatment is better than other physiotherapy breathing techniques in patients undergoing abdominal or thoracic surgery. There is a lack of studies investigating the effect of PEP over placebo or no physiotherapy treatment.

1 - 36 of 36
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