None listed
Conditions
Brief summary
Upper Abdominal Surgery (UAS) is a common surgical procedure, with average hospitalisation of 11.4 days. Breathing problems are a major contributor to longer periods of hospitalisation following UAS, and account for nearly 25% of deaths within 6 days of surgery. The incidence of such breathing problems following UAS is as high as 53%. There is a need for evidence-based approaches to reduce these rates, with potential benefits including reduced hospitalisation and healthcare costs, improved quality of care, and improved patient outcomes and quality of life. Research suggests that postoperative physiotherapy should be targeted towards high-risk patients, and is effective in reducing the incidence of breathing complications compared to no postoperative physiotherapy. However, potential benefits of additional preoperative physiotherapy for patients undergoing elective UAS have not been established. A randomised trial will be undertaken comparing current practice (postoperative physiotherapy only) to a program incorporating a preoperative physiotherapy session combined with postoperative physiotherapy. It is proposed that a single, preoperative physiotherapy session in the Pre Admission Clinic (PAC) setting would improve the quality of physiotherapy care for these patients. The aims of this preoperative session would be to: (a) Reduce the incidence of breathing problems; (b) Reduce patient anxiety during the first postoperative physiotherapy session; (c) Decrease the physiotherapist’s overall patient contact time, thus improving efficiency of the physiotherapy service. The study will investigate 4 questions: (a) Does preoperative physiotherapy reduce the incidence of breathing problems compared with standard management? (b) Does the timing of physiotherapy intervention (preoperative and postoperative vs. postoperative only) affect patient anxiety during the first postoperative physiotherapy session? (c) Does preoperative physiotherapy reduce overall physiotherapy contact time compared with standard management? (d) Should preoperative physiotherapy only be provided to patients at high risk of postoperative breathing problems?
Interventions
Patients randomised to the treatment group will receive postoperative physiotherapy. This includes tansferring out of bed on the first postoperative day with the assistance of the physiotherapist, as well as the completion of specifically targeted breathing, lower limb exercises and graduated walking. These patients will continue to receive physiotherapy, aimed at progressing the patient's mobility and respiratory function, until it is deemed no longer necessary by the treating physiotherapist.
Patients randomised to the treatment group will receive postoperative physiotherapy. This includes tansferring out of bed on the first postoperative day with the assistance of the physiotherapist, as well as the completion of specifically targeted breathing, lower limb exercises and graduated walking. These patients will continue to receive physiotherapy, aimed at progressing the patient's mobility and respiratory function, until it is deemed no longer necessary by the treating physiotherapist. The frequency and duration of the postoperative physiotherapy sessions will be at the discretion of the treating physiotherapist, as individual patients may require more or less physiotherapy input depending on their rate of progression. Patients in the treatment group will also receive a single session of physiotherapy preoperatively of 30-45 minutes duration (45 minutes will be allowed for patients requiring an interpreter).This preoperative session will take place approximately 1-2 weeks prior to surgery. During this preoperative session, the physiotherapist will collect information including the patient’s past medical history, social history and details of their pre-morbid physical functioning. The patients will be educated regarding their surgery, the complications often associated with surgery that may be reduced by participating in physiotherapy, and the rationale for postoperative physiotherapy. They will be given the opportunity to practise the specific breathing and lower limb exercises to be performed postoperatively and to ask the physiotherapist any questions.
Sponsors
Northern Health
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients undergoing elective upper abdominal surgery presenting to the Preadmission Clinic at The Northern Hospital. Patients 18 years and older.
Exclusion criteria
Failure to consent; and Score < 7 on the Abbreviated Mental Test Score (AMTS)
Outcome results
None listed