None listed
Conditions
Brief summary
It has become routine for any adult who had undergone abdominal surgery to have physiotherapy treatments such as deep breathing, incentive spirometry, encouraging mobilisation (getting out of bed) and other specific chest physiotherapy techniques manual techniques. It is thought that this physiotherapy will prevent post-operative pulmonary complications. The research in adults has shown that of these techniques, early upright mobilisation is most effective in reducing length of stay in hospital for adults who have undergone abdominal surgery (Browning et al 2007). There is very little published evidence to support the use of physiotherapy to prevent post-operative complications in children who have undergone abdominal surgery. Current medical, physiotherapy and nursing care after abdominal surgery at Princess Margaret Hospital (PMH) advocates for early mobilisation. These recommendations for children are based on findings on adult patients. As a result, there are no clear guidelines of how much, how often, and how best to encourage mobilisation in children after they have had abdominal surgery. This uncertainty leaves clinicians working in this clinical area partly dependant on their own clinical experience when making decisions regarding individual patient management and results in variation in clinical care (Morris et al 2003). This uncertainty and variation in clinical practice is one of the driving forces behind the development and evaluation of the Up and Go Goodie Bag. AIM: We wish to evaluate whether patients supplied with a self-directed early mobilization and deep breathing incentive goodie bag (Up, and Go Goodie Bag ) after abdominal surgery facilitates early mobilisation, early discharge and prevents post op pulmonary complications. This information will be used to develop mobilisation guidelines for children who have undergone abdominal surgery.
Interventions
Intervention (Up and Go Goodie Bag)
The "Up and Go" Goodie Bag will include child-friendly age appropriate information on the benefits of early upright mobilization and breathing exercises in the post-operative period. The information will include instruction on how to perform the breathing exercise routine and how to perform supported coughing. Incentives to encourage these exercises will include the provision of age appropriate toys such as whistles and bubble blowers. Incentives to encourage
Intervention (Up and Go Goodie Bag) The "Up and Go" Goodie Bag will include child-friendly age appropriate information on the benefits of early upright mobilization and breathing exercises in the post-operative period. The information will include instruction on how to perform the breathing exercise routine and how to perform supported coughing. Incentives to encourage these exercises will include the provision of age appropriate toys such as whistles and bubble blowers. Incentives to encourage upright mobilization and completion of breathing exercises will include sticker charts with rewards for reaching goal points. Consumers, including the youth advisory committee of PMH will be consulted about the presentation of the information and contents of the Up and Go Goodie Bag. The goodie bag is administered day 0, i.e., day of the surgery, but post operatively on the day of the surgery. The goodie bags, activities and incentives cover the first 5 days post operatively until discharge. The minimum recommended frequency would be ten deep breaths (ie one breathing exercises/activity) per hour that the child is awake or one period of upright mobilisation, which includes sitting out of bed, or assisted walking per hour the child is awake. The time of upright mobilsation is dependent on recovery stage i.e., day post op with increasing time expected as days progress. The frequency of breathing exercises and upright time are outcomes being assessed within this trial to determine recommended recommended protocols as there is currently no good data of what to recommend for children. Parental support to initiate and complete activities is required. It is anticipated that older aged children (10-12 year old) may show self initiation but this is uncertain.
Sponsors
Princess MArgaret Hospital
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
4 Years to 12 Years
Healthy volunteers
No
Inclusion criteria
Patients undergoing abdominal surgery (open or laparoscopic, upper or lower) Child or parent able to understand simple age-appropriate written English Admitted to Ward 5C (surgical ward) Return to the ward (5C ) the day of their surgery.
Exclusion criteria
Post operative order request for rest in bed for greater than 24 hours. Patients who return for further surgery within the first 4 post operative days Patients with any pre-existing, tertiary hospital managed respiratory condition other than asthma Non-ambulant patients (eg. children with Cerebral Palsy GMFCS level IV and V) Patients operated on Saturday or Sunday Inability to understand English
Outcome results
None listed