Association of Chartered Physiotherapists in Respiratory Care scoping review: Post-operative physiotherapy in people undergoing thoracic surgery

Introduction This scoping review was produced by the ACPRC ed- itorial board. Following a preliminary scoping day, surgery was considered 1 of 5 key priorities for review. Surgery was subsequently separated into specialities. Objective The objective of this scoping review was to report the extent and methodological type of evidence associ- ated with post-operative physiotherapy in people who underwent thoracic surgery. Inclusion criteria Studies with adult patients undergoing thoracic sur- gery and published between 2014 and 2020 were in- cluded. The thoracic procedure undertaken required post-operative physiotherapy intervention as part of the recovery process. Method Searches were undertaken in PEDro, CINAHL, EM- BASE, MEDLINE, PubMed, Google Scholar and the Clinical Trials Registry. Article titles and abstracts were screened by one reviewer, and full text articles appraised by two reviewers. Quality was assessed and data was extracted using the relevant tools dependent on study methodology. Results Initially, 1809 articles were retrieved from which 28 articles were included in this scoping review, including a total of 6265 participants. Studies were randomised control trials (n = 10), observational studies (n = 7) and systematic review or meta-analysis (n = 5). The quality of the articles was good with the studies having structured protocols and blinding of sub- jects where appropriate, however there were some methodical flaws, including being underpowered. The variability in clinical physiotherapy practice be- tween countries was highlighted. Included studies explored respiratory physiotherapy (n = 13), mobilisation (n = 10), combined respiratory and mobilisation (n = 3), kinesiology taping (n = 1) and outcomes (n = 1). Early and intensive mobilisation as part of an ERAS programme demonstrated statistically significant reduction in length of stay, post-operative pulmonary complications, and morbidity. The level of patients’ pre-operative mobility impacted on their post-operative outcomes and risk of developing post-operative pulmonary complications (PPC). Conclusion The scoping review included 28 studies with a range of methodologies providing evidence that supports post-operative physiotherapy intervention in people who undergo thoracic surgery. Future research should aim to clarify which respiratory physiotherapy tech- niques impact recovery and expand the diversity of methodologies to include more qualitative research

Association of Chartered Physiotherapists in Respiratory Care scoping review: Post-operative physiotherapy in people undergoing thoracic surgery

Introduction This scoping review was produced by the ACPRC editorial board. Following a preliminary scoping day, surgery was considered 1 of 5 key priorities for review. Surgery was subsequently separated into specialities. Objective The objective of this scoping review was to report the extent and methodological type of evidence associated with post-operative physiotherapy in people who underwent thoracic surgery. Inclusion criteria Studies with adult patients undergoing thoracic surgery and published between 2014 and 2020 were included. The thoracic procedure undertaken required post-operative physiotherapy intervention as part of the recovery process. Method Searches were undertaken in PEDro, CINAHL, EMBASE, MEDLINE, PubMed, Google Scholar and the Clinical Trials Registry. Article titles and abstracts were screened by one reviewer, and full text articles appraised by two reviewers. Quality was assessed and data was extracted using the relevant tools dependent on study methodology. Results Initially, 1809 articles were retrieved from which 28 articles were included in this scoping review, including a total of 6265 participants. Studies were randomised control trials (n = 10), observational studies (n = 7) and systematic review or meta-analysis (n = 5). The quality of the articles was good with the studies having structured protocols and blinding of subjects where appropriate, however there were some methodical flaws, including being underpowered. The variability in clinical physiotherapy practice between countries was highlighted. Included studies explored respiratory physiotherapy (n = 13), mobilisation (n = 10), combined respiratory and mobilisation (n = 3), kinesiology taping (n = 1) and outcomes (n = 1). Early and intensive mobilisation as part of an ERAS programme demonstrated statistically significant reduction in length of stay, post-operative pulmonary complications, and morbidity. The level of patients’ pre-operative mobility impacted on their post-operative outcomes and risk of developing post-operative pulmonary complications (PPC). Conclusion The scoping review included 28 studies with a range of methodologies providing evidence that supports post-operative physiotherapy intervention in people who undergo thoracic surgery. Future research should aim to clarify which respiratory physiotherapy techniques impact recovery and expand the diversity of methodologies to include more qualitative research

An Evaluation of Service Provision and Novel Strength Assessment on Patient Outcomes in a UK based Pulmonary Rehabilitation Setting

This study’s purpose was to (i) assess the impact of a 7-week Pulmonary Rehabilitation (PR) programme upon patient outcomes; incremental shuttle walk test (ISWT), COPD assessment tool (CAT), Clinical COPD Questionnaire (CCQ) and the Hospital Anxiety and Depression Scale (HADS); (ii) assess the impact of COPD severity on ISWT and psychological functioning and quality of life measures following PR; (iii) assess the feasibility of incorporating individually prescribed one repetition maximum (1RM) training loads into the existing strength training programme. Patients were people with COPD enrolled onto one of three versions (locations A, B & C) of a 7-week PR programme, which consisted of group exercise sessions and a social plus education element. Two locations incorporated individually prescribed training loads. Minimal Clinically Important Changes (MCIC) are reported for the ISWT across all locations. Statistically significant changes in both CAT and the CCQ were found, with MCIC’s evident for CAT score overall and individually at location B. MCIC’s were not found for the CCQ. No statistically significant or MCIC were evident for the HADS. MCIC’s were present only in patients with mild to moderate severity for the ISWT. For the CAT, moderate, severe and very severe patients with COPD experienced MCIC’s. MCIC’s and statistically significant increases in 1RM strength were seen at both locations. These findings evidence an effective PR service. Basic strength exercise programming and assessment are feasible and should be implemented in PR services to maximize patient outcomes

Differences in patient outcomes between a 6, 7 and 8 week pulmonary rehabilitation programme: A service evaluation

Objective: To investigate changes and differences in patient outcomes over time for 6, 7 and 8 week pulmonary rehabilitation programmes in order to identify optimal duration. Setting: Community based pulmonary rehabilitation programmes in the East of England. Participants: In total 363 participants completed one of the three pulmonary rehabilitation programmes. Patients with a chronic respiratory condition showing a commitment to the pulmonary rehabilitation programme and no contraindications to exercise were included. Intervention: Pulmonary rehabilitation twice a week for 6, 7 or 8 weeks. Main outcome measures: St Georges Respiratory Questionnaire (SGRQ), Clinical COPD Questionnaire (CCQ), Hospital Anxiety and Depression Scale (HADS) and Incremental Shuttle Walk Test (ISWT). Results: All programmes showed improvements in ISWT post rehabilitation, with the 8 week programme showing the greatest improvement. Conclusion: Findings show that greatest improvements in terms of exercise capacity may be seen from 8 week pulmonary rehabilitation programmes, but that improvement for the ISWT can be obtained from 6, 7 or 8 week programmes

ACPRC scoping review of post-operative physiotherapy in people undergoing cardiac surgery

Introduction This scoping review was produced by the ACPRC editorial board. Surgery was considered one of five key priorities for review and was subsequently separated into surgical specialities. Objective The objective of this scoping review was to report the extent and methodological type of evidence associated with post-operative physiotherapy in people who underwent cardiac surgery. Inclusion criteria Studies with adult patients undergoing cardiac surgery, requiring post-operative physiotherapy intervention, as part of the recovery process, and published between 2014 and 2021 were included. Method Searches were undertaken in PEDro, CINAHL, EMBASE, MEDLINE, PubMed, Google Scholar and the Clinical Trials Registry. Article titles and abstracts were screened by one reviewer, and full text articles appraised by two reviewers. Quality was assessed and data was extracted using the relevant tools. Results Initially, 2795 articles were retrieved, 41 articles were included in this scoping review. The most frequent study methodologies were randomised control trials (n = 21), observational studies (n = 8), systematic reviews (n = 3) and qualitative studies (n = 2). The sample sizes tended to be small and single centred. Included studies explored mobilisation (n = 18), respiratory physiotherapy (n = 12), sternal wound precautions (n = 7), staff or patient experience (n = 3) and adverse events (n = 1). Targeted respiratory physiotherapy may be beneficial for patients who are at high-risk of developing or have developed post-operative complications. Early mobilisation shows good evidence to reduce length of stay. Allowing patients more liberal use of their upper-limbs has also been shown to expedite recovery and reduce care needs on discharge without increasing sternal wound breakdown, infection or pain. Conclusion The literature showed positive outcomes for physiotherapy interventions involving early mobility and allowing an increase in upper-limb usage. Respiratory physiotherapy techniques are beneficial when used with appropriate patients. Cost effectiveness analysis should be undertaken. There is scope for an increase in qualitative studies to be undertaken to focus on patient experience and patient reported outcomes