Pre- and postoperative physiotherapyAl Jaaly E, Fiorentino F, Reeves BC et al (2013) Effect of adding postoperative noninvasive ventilation to usual care to prevent pulmonary complications in patients undergoing coronary artery bypass grafting: a randomized controlled trial. J Thorac Cardiovasc Surg; 146(4):912-8. doi: 10.1016/j.jtcvs.2013.03.014
Baddeley RA (2016) Physiotherapy for enhanced recovery in thoracic surgery. J Thoracic Dis; 8(Suppl 1):S107-S110. doi: 10.3978/j.issn.2072-1439.2015.12.02.
Banasik (1996) Effect of lateral position on arterial and venous blood gases in postoperative cardiac surgery patients. Am J Crit Care, 5, 121-6
• right-side-lying is better than left-side-lying for blood gases after heart surgery
Basse L (2000) A clinical pathway to accelerate recovery after colonic resection. Ann Surg, 232, 51-7
• post-op rehab reduces hospital stay
Boden I, Browning L, Skinner EH et al (2016) The LIPPSMAck POP (Lung Infection Prevention Post Surgery - Major Abdominal - with Pre-Operative Physiotherapy) trial: study protocol for a multi-centre randomised controlled trial. Trials; 16:573. doi: 10.1186/s13063-015-1090-6.
Bonde P, Mc Manus K, McAnespie M et al (2002) Lung surgery: identifying the subgroup at risk for sputum retention. Eur J Cardiothorac Surg, 22, 18-22
• pre-operatively, lung surgery patients at risk of sputum retention can be predicted by one of: current smokers, history of COPD, CVA, or ischaemic heart disease, and absence of regional analgesia
Branson RD (2013) The scientific basis for postoperative respiratory care. Respir Care; 58(11):1974-84
Brasher PA, McClelland KH, Denehy L (2003) Does removal of deep breathing exercises from a physiotherapy programme alter patient outcomes? Austr J Physiother, 49, 165-73
• breathing exercises appear unnecessary after cardiac surgery
Brooks D, Crowe J, Kelsey CJ et al (2001) A clinical practice guideline on peri-operative cardiorespiratory physical therapy. Physiother Canada, 53, 1, 9-25.
• translates evidence into practice
Browning L, Denehy L, Scholes RL (2007) The quantity of early upright mobilisation performed following upper abdominal surgery is low: an observational study. Austr J Physiotherapy, 53, 1, 47-52
Brunelli A, Monteverde M, Al Refai M et al (2004) Stair climbing test as a predictor of cardiopulmonary complications after pulmonary lobectomy in the elderly. Ann Thorac Surg, 77, 266-70
• a symptom-limited stair climbing test accurately predicts cardiopulmonary complications
Bruton A, Donovan H, Langridge E (2009) The Southampton physiotherapy post-operative screening tool. ACPRC Journal, 41, 9-15
Cereda M, Neligan PJ, Reed AJ (2013) Noninvasive respiratory support in the perioperative period. Curr Opin Anaesthesiol; 26(2):134-40. doi: 10.1097/ACO.0b013e32835e8002.
Cheifetz O, Lucy D, Overend TJ (2010) The effect of abdominal support on functional outcomes in patients following major abdominal surgery. Physiother Can, 62, 3, 242-53
Choi WW, Au TK, Fung YK et al (2013) Efficacy of a perioperative physiotherapy care programme for patients undergoing abdominal surgery in Tseung Kwan O Hospital. Hong Kong Physiother J, 31(2):102-103
Coen PM, Goodpaster BH (2016) A role for exercise after bariatric surgery? Diabetes Obes Metab; 18(1):16-23. doi: 10.1111/dom.12545
Diane J (2007) Exercise, quality of life and symptoms in men and women five to six years after coronary artery bypass graft surgery. Heart Lung, 36, 6, 387-97
• regular exercise improves on-going quality of life 5 to 6 years after CABG
Dhesi JK, Swart M (2016) Specialist pre-operative assessment clinics. Anaesthesia; 71(S1):3–8. doi: 10.1111/anae.13307
• the pre-assessment clinic should include rehabilitation and discharge planning
Dronkers J (2008) Prevention of pulmonary complications after upper abdominal surgery by preoperative IMT. Clin Rehabil, 22, 134-42
• preoperative inspiratory muscle training reduces atelectasis in patients having elective abdominal aortic aneurysm surgery
Durrant V, Moore K (2004) Early mobilisation of post-surgical patients. ACPRC Journal, 36, 32-6
• review of evidence base and application of post-op mobilisation
Ebeo CT et al (2002) The effect of BiPAP on postoperative pulmonary function following gastric surgery for obesity. Respir Med, 96, 672-6
• postop BiPAP for obese patients improves lung function but not complication rate
Edvardsen E, Skjønsberg OH, Holme I et al (2015) High-intensity training following lung cancer surgery: a randomised controlled trial. Thorax; 70:244-250. doi:10.1136/thoraxjnl-2014-205944
• high-intensity endurance and strength training after lung cancer surgery is well tolerated and improves fitness and quality of life
Faintuch J (2013) Rehabilitation needs after bariatric surgery. Europ J Phys Rehab Med, 49(3): 431-7
Gbiri CAO, Ajepe TO, Akinbo SRA (2016) Efficacy of chest physiotherapy and incentive spirometry in improving cardiovascular and pulmonary functional performances in individuals post-thoraco-abdominal surgery: a randomised controlled study. Internat J Ther Rehab Research; 5(2):1-8
Halm MA (2015) East meets West: effects of massage on the experience of cardiac surgery patients. Am J Crit Care; 24:176-180. doi:10.4037/ajcc2015947
Hoffman AJ, Brintnall RA, Brown JK et al (2014) Too sick not to exercise: using a 6-week, home-based exercise intervention for cancer-related fatigue self-management for postsurgical non-small cell lung cancer patients. Cancer Nurs; 36(3):175-88. doi: 10.1097/NCC.0b013e31826c7763.
• postoperative home-based exercise can reduce fatigue
Hulzebos EH, Smit Y, Helders PP et al (2013) Preoperative physical therapy for elective cardiac surgery patients. Cochrane Database Syst Rev. Nov 14;11:CD010118. doi: 10.1002/14651858.CD010118.pub2.
• postoperative atelectasis and pneumonia may be reduced by preoperative exercise and breathing exercises
Jaber S, De Jong A, Castagnoli A et al (2014) Non-invasive ventilation after surgery. Ann Fr Anesth Reanim; 33(7-8):487-91. doi: 10.1016/j.annfar.2014.07.742.
• postoperative NIV can improve gas exchange, decrease the work of breathing and reduce atelectasis.
Jarski RW (2000) The effectiveness of osteopathic manipulative treatment following surgery. Alt Therapies, 6, 5, 77-81
• stairs done 20% earlier, walking 43% further, less analgesia, shorter hospital stays than control group
Kawamura H (1999) The effects of pre-and-postoperative contralateral TENS for phantom limb pain in amputees. WCPT Proceedings, p.61
• TENS to remaining limb given to sites corresponding to painful sites on amputated limb
Marseu K, Slinger P (2016) Peri-operative pulmonary dysfunction and protection. Anaesthesia; 71 Suppl 1:46-50. doi: 10.1111/anae.13311
• pre-operative exercise training reduces postoperative pulmonary complications
Martin PS, Braga AC, Meira CA et al (2013) Implementation of a guideline for physical therapy in the postoperative period of upper abdominal surgery reduces the incidence of atelectasis and length of hospital stay. Rev Port Pneumol; 20(2)69–77. doi: 10.1016/j.rppneu.2013.07.005
Martin JB, Garbee D, Bonanno L (2016) Effectiveness of positive end-expiratory pressure, decreased fraction of inspired oxygen and vital capacity recruitment maneuver in the prevention of pulmonary atelectasis in patients undergoing general anesthesia: a systematic review. JBI Database System Rev Implement Rep; 13(8):211-49. doi: 10.11124/jbisrir-2015-1410
McConnelee LE (2009) Pre- and postcardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery: a randomized control trial. Am J Phys Med Rehab, 88, 7, 591-592
Moran J, Wilson F, Guinan E et al (2016) Role of cardiopulmonary exercise testing as a risk-assessment method in patients undergoing intra-abdominal surgery: a systematic review. Br J Anaesth; 116(2):177-91. doi: 10.1093/bja/aev454
• exercise testing is a useful preoperative risk-stratification tool that can predict postoperative outcome
Nikolić I, Majerić-Kogler V, Plavec D (2008) Stairs climbing test with pulse oximetry as predictor of early postoperative complications in functionally impaired patients with lung cancer and elective lung surgery: prospective trial of consecutive series of patients. Croat Med J, 49, 1, 50–57. doi: 10.3325/cmj.2008.1.50
Pasqua F (2012) Intensive long-term pulmonary rehabilitation program after oesophagectomy, a reflection. Multidisciplinary Respir Med, 7, 22. doi:10.1186/2049-6958-7-22
Pasquina P, Tramer MR, Granier J-M et al (2006) Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery. Chest, 130, 6, 1887 - 99
• systematic review identifying ‘a few’ trials supporting prophylactic post-op physiotherapy
• routine physiotherapy not justified
Pratt-Harrington (1995) The effect of osteopathic manipulative treatment in the post abdominal surgical patient. Am Ass Osteopathy J, Fall, 9-13
• outcome - improved spirometry readings compared to controls
Ribeiro S, Viana E, Spaniol A et al (2014) Evaluation of measure functional independence in patients mastectomized with armpit lymphadenectomy after physiotherapeutic preoperative treatment. Arch Phys Med Rehabil; 95(10):e45-e46
Romera-Villegas A, Cairols-Castellote MA, Vila-Coll R et al (2008) Early mobilisation in patients with acute deep vein thrombosis does not increase the risk of a symptomatic pulmonary embolism. International Angiology; 27(6):494-9
• early walking does not influence the incidence of symptomatic pulmonary embolism.
Sala V, Petrucci L, Monteleone S et al (2016) Oxygen saturation and heart rate monitoring during a single session of early rehabilitation after cardiac surgery. Europ J Phys Rehab Med; 52(1):12-9
Silva YR, Li SK, Rickard MJFX (2013) Does the addition of deep breathing exercises to physiotherapy-directed early mobilisation alter patient outcomes following high-risk open upper abdominal surgery? Cluster randomised controlled trial. Physiother, 99, 3, 187-193
Smith MCL (2000) Is retained mucus a risk factor for the development of postoperative atelectasis and pneumonia? Physiother Theory Pract, 16, 69-80
Singh PM, Borle A, Shah D et al (2016) Optimizing prophylactic CPAP in patients without obstructive sleep apnoea for high-risk abdominal surgeries: a meta-regression analysis. Lung; 194(2): 201-217. doi: 10.1007/s00408-016-9855-6
• prophylactic postoperative CPAP reduces the incidence of postoperative pulmonary complications in patients undergoing high-risk abdominal surgery.
• the protective effect diminishes with increasing level of CPAP
Sterzi S (2013) Post-operative rehabilitation for surgically resected non-small cell lung cancer patients: Serial pulmonary functional analysis. J Rehab Med, 45(9):911-915. doi: 10.2340/16501977-1192
Takahama M, Mimura Y, Matsuda E (2013) Complications influence ambulation in patients undergoing extrapleural pneumonectomy. Hong Kong Physiother J, 31(1):52-53
Tandon M, Singh A, Saluja V et al (2016) Validation of a new “objective pain score” vs. “numeric rating scale” for the evaluation of acute pain: a comparative study. Anesthesiology Pain Med; 6(1):e32101. doi: 10.5812/aapm.32101.
• acute pain in the post-operative period should be assessed at rest and during movement
Tomczak CR et al (2013) Effect of exercise training on pulmonary oxygen uptake kinetics in heart transplant recipients. Am J Cardiol; 112(9):1489-1492
Trujillo-Santos J, Perea-Milla E, Jiménez-Puente A et al (2005) Bed rest or ambulation in the initial treatment of patients with acute deep vein thrombosis or pulmonary embolism: findings from the RIETE registry. Chest; 127(5):1631-6
• bed rest has no influence on the risk of developing PE in patients with acute DVT
• bed rest has no influence in patients with acute submassive PE.
Van der Leeden M, Huijsmans R, Geleijn E et al (2016) Early enforced mobilisation following surgery for gastrointestinal cancer: feasibility and outcomes. Physiotherapy; 102(1):103–110. doi: dx.doi.org/10.1016/j.physio.2015.03.3722
Varela G, Ballesteros E, Jimenez MF et al (2006) Cost-effectiveness analysis of prophylactic respiratory physiotherapy in pulmonary lobectomy. Eur J Cardiothorac Surg, 29, 216-20
• physiotherapy involving deep breathing and coughing, treadmill, ergometric cycling, and upper limb exercise (starting pre-operatively and continuing until discharge), showed reduced atelectasis, pneumonia and length of stay, compared to incentive spirometry alone
Westerdahl E, Lindmark B, Eriksson T et al (2003) The immediate effects of deep breathing exercises on atelectasis and oxygenation after cardiac surgery. Scand Cardiovasc J, 37, 363-7
• a single session of 30 deep-breaths reduces atelectasis and increases oxygenation on the second postoperative day after CABG
Westerdahl E (2005) Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery Chest, 128: 3482-8.
• patients who performed 30 slow deep breaths (against a positive expiratory pressure of 10 cm H2O) hourly during daytime for the first 4 postoperative days after CABG had significantly smaller atelectatic areas and better pulmonary function.
ACPRC = Association of Chartered Physiotherapists in Respiratory Care
CABG = coronary artery bypass graft
FRC = functional residual capacity
JAMA = Journal of American Medical Association