Patman, Shane

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The University of Notre Dame Australia ResearchOnline@ND Physiotherapy Papers and Journal Articles School of Physiotherapy 2018 Critically appraised paper: Preoperative physiotherapy education halved postoperative pulmonary complications in patients after upper abdominal surgery [commentary] Shane Patman The University of Notre Dame Australia, shane.patman@nd.edu.au Follow this and additional works at: https://researchonline.nd.edu.au/physiotherapy_article  Part of the Physical Therapy Commons, and the Physiotherapy Commons  This other was originally published as: Patman, S. (2018). Critically appraised paper: Preoperative physiotherapy education halved postoperative pulmonary complications in patients after upper abdominal surgery [commentary]. Australian Journal of Physiotherapy, 64 (3), 195. Original other available here: https://doi.org/10.1016/j.jphys.2018.04.007 This other is posted on ResearchOnline@ND at https://researchonline.nd.edu.au/physiotherapy_article/140. For more information, please contact researchonline@nd.edu.au. This is an Open Access article distributed in accordance with the Creative Commons Attribution-Non Commercial-No Derivatives 4.0 International license (CC BY-NC-ND 4.0), which permits others to copy and redistribute the material in any medium or format. You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you many not distribute the modified material. See: https://creativecommons.org/licenses/by-nc-nd/4.0/   This article originally published in the Australian Journal of Physiotherapy available at: https://doi.org/10.1016/j.jphys.2018.04.007    No changes have been made to this article.  Patman, S. (2018) Critically appraised paper: Preoperative physiotherapy education halved postoperative pulmonary complications in patients after upper abdominal surgery [commentary]. Australian Journal of Physiotherapy, 64(3), 195. doi: 10.1016/j.jphys.2018.04.007     AppraisalCritically appraised paper: Preoperative physiotherapy education halvedpostoperative pulmonary complications in patients after upper abdominal surgery[commentary]CommentaryThe trial results pointtowards aneffective interventioninwhich asingle 30-minute preoperative coaching session from a physiother-apist on breathing exercises can halve the incidence of postoperativepulmonary complications after upper abdominal surgery. However,there were several imbalances in the randomised groups that mightexplain some of the effect. The intervention group: was younger; hadlower American Society of Anaesthesiology scores; had fewerrespiratory, diabetes and cardiac co-morbidities; had fewer currentsmokers and had a lower pack-year history. Additionally, theintervention group reportedly had higher preoperative handgripstrengthandestimatedVO2max.Further, lessuppergastrointestinal/hepatobiliary surgeries were performed in the intervention group.Are any of these large enough to create an unbalanced risk profilebetween intervention and control groups, and therefore cast doubton the results? Probably not in isolation, but collectively? Theinvestigators undertook adjustments to their results for somebaseline variables considered to potentially affect the primaryoutcome, but it is speculative whether this was sufficient. What isknown is that presently, preadmission education by physiothera-pists for those undergoing upper abdominal surgery is not usual carein Australian and New Zealand hospitals.1 Therefore, for clinicalpractice change to occur, results have to pass the ‘water cooler test’. Itintuitively seems too good to be true that such a minimal-riskpreoperative intervention of ‘shock and awe’ education on risks ofpostoperative pulmonary complications along with coaching onsimple breathing exercises would have the profound impact ofhalving complications in the upper abdominal surgery cohort.Implementation challenges could occur if decision-makers were notfully convinced by or committed to the results. Anecdotally,physiotherapy preoperative assessment and education of thoseundergoing ‘at-risk’ surgery, such as cardiac, lung lobectomy andupper abdominal surgery, was prevalent in the later part of the 20thcentury2 but funding for preoperative education, in the absence ofevidence, has long been directed elsewhere. This trial is generatingmuch conversation, but needs replicating across jurisdictions beforethe water cooler chatter can settle and practice change ensues.Provenance: Invited. Not peer reviewed.Shane PatmanSchool of Physiotherapy, The University of Notre Dame Australia,Perth, AustraliaReferences1. Patman S, et al. Arch Physiother. 2017;7:11.2. Reeve J, et al. N Z J Physiother. 2016;44:33–49.Journal of Physiotherapy xxx (2018) xxx–xxxG ModelJPHYS-425; No. of Pages 1Please cite this article in press as: Patman S. Critically appraised paper: Preoperative physiotherapy education halved postoperativepulmonary complications in patients after upper abdominal surgery [commentary]. J Physiother. (2018), https://doi.org/10.1016/j.jphys.2018.04.007J o u r n a l o fPHYSIOTHERAPYjou r nal h o mep age: w ww.els evier . co m/lo c ate / jp hyshttps://doi.org/10.1016/j.jphys.2018.04.0071836-9553/© 2018 Published by Elsevier B.V. on behalf of Australian Physiotherapy Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Critically appraised paper: Preoperative physiotherapy education halved postoperative pulmonary complications in patients after upper abdominal surgery [commentary]

https://researchonline.nd.edu.au/cgi/viewcontent.cgi?article=1143&amp;context=physiotherapy_article

Critically appraised paper: Preoperative physiotherapy education halved postoperative pulmonary complications in patients after upper abdominal surgery [commentary]

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