Thoracic Surgery
Conditions
Keywords
Physiotherapy, Thoracic surgery, Exercises
Brief summary
Thoracic surgery is the primary intervention used in the treatment of diseases affecting the lungs, pleura, chest wall, and mediastinum. Postoperative changes occur in both lung functions and clinical symptoms due to the procedure itself and patient-related factors. After thoracic surgery, patients often experience reduced exercise tolerance and impaired respiratory functions, negatively affecting their participation in daily activities, functional levels, and quality of life. In open thoracotomies, the incision site, severed muscles, and the size of the incision can impact upper extremity and trunk functions. The aim of this study is to investigate the effects of physiotherapy applied through digital methods on respiratory functions, respiratory muscle strength, functional capacity, upper extremity muscle strength, and quality of life in patients who have undergone thoracic surgery.
Detailed description
Thoracic surgery is a primary intervention used in the treatment of diseases of the lungs, pleura, chest wall, and mediastinum. Following surgery, changes in lung function and associated clinical symptoms may occur due to both the surgical procedure itself and patient-specific factors, and these may present intraoperatively and/or postoperatively. These changes are primarily restrictive in nature and may include a characteristic reduction in lung volume, a decrease in functional residual capacity that may lead to atelectasis, slowed mucociliary clearance, gas exchange abnormalities, and especially reduced chest expansion on the operated side. Additionally, problems in surfactant production and diaphragmatic dysfunction may also arise. Furthermore, the use of surgical drains, the nature of the surgical procedure, the integrity of the remaining lung tissue after resection, and the limitations caused by enforced immobility can all contribute to the development of various postoperative complications. Preventing and/or managing these postoperative complications is essential for enabling the patient to return to functional life, reducing long-term healthcare utilization, and improving survival rates. For this reason, pulmonary rehabilitation is indicated after thoracic surgeries. One of the methods of delivering rehabilitation is telerehabilitation, which allows patients to access therapy remotely. In this study, however, the term Digital Physiotherapy, which is a more current and comprehensive term recommended by World Physiotherapy, will be used. In the literature review, it was observed that most postoperative studies following thoracic surgery focus on the in-hospital period, while studies conducted after discharge are usually of short duration. The aim of this study is to examine the effects of long-term physiotherapy delivered through digital methods following thoracic surgery.
Interventions
OTHERStandard care
Patients will receive education regarding the critical aspects to consider after hospital discharge. Standard postoperative care protocols will be implemented.
OTHERExercise
Exercise sessions will begin with flexibility exercises targeting the shoulder and neck regions. This will be followed by breathing exercises utilizing fundamental respiratory techniques. Extremity exercises will include movements focused on the upper extremities and trunk, with progression applied according to a pre-established plan. Each session will conclude with cool-down exercises. Additionally, patients will be encouraged to engage in regular walking on a weekly basis.
Sponsors
Bezmialem Vakif University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Patients who underwent open thoracotomy * Agreement to participate in the study * Being between the ages of 18-75 * Having an internet connection at home and being able to participate in video-conference sessions via desktop-laptop computers, smartphones, electronic tablets, etc.
Exclusion criteria
* Pneumonectomy surgeries * Having a cardiac, orthopedic, neurological or systemic disease that would prevent exercise * Having mental, communication or behavioral disorders that would cause problems in understanding commands and questions or performing exercises. * Participating in a pulmonary rehabilitation program before surgery * Having been hospitalized for any pulmonary disease during the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Health Related Quality of Life | 12 weeks | Saint George Respiratory Questionnaire Results. Scores range from 1 to 100. Higher scores mean worse health. |
| Tiffeneau ratio (FEV1/FVC) | 12 weeks | The FEV1/FVC represents the fraction of air a patient exhales in the first second. This measurement is crucial for detecting airflow obstruction. |
| Peak expiratory flow (PEF) | 12 weeks | Peak Expiratory Flow (PEF) is defined as a maximal expiratory flow generated during a simple maneuver using a peak flow meter via a mouthpiece. |
| Respiratory Muscle Strength | 12 weeks | Maximum inspiratory and expiratory pressures are measured using an intraoral pressure measuring device. |
| Functional Capacity | 12 weeks | Six-Minute Walking Test Distance measurement (in meter). |
| Upper Extremity Peripheral Muscle Strength | 12 weeks | Measurement of shoulder flexion and abduction muscle strength using an electronic hand dynamometer. |
| Forced vital capacity (FVC) | 12 weeks | The volume of air exhaled during a full and strongest exhalation possible after a full inspiration, as measured by a spirometry device. |
| Forced expiratory volume in 1 second (FEV1) | 12 weeks | FEV1 is the expiratory volume in the first second of the FVC maneuver. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Trunk Lateral Flexion Flexibility | 12 weeks | It is the measurement of the distance between the first and last points during lateral flexion of the trunk with a tape measure. (in centimeters) |
| Chest Expansion | 12 weeks | Evaluation of change in chest expansion. The largest differences between maximum inspiration and maximum expiration is recorded as chest expansion. |
| Shoulder Pain | 12 weeks | Assessment is made using the Shoulder Pain and Disability Index. Higher scores indicate more severe pain and greater disability. |
| Sleep | 12 weeks | Assessment is made using the Insomnia Severity Index. Scores range from 0-28. A score of 8 or above is considered insomnia. |
| Shoulder Joint Range of Motion Measurement | 12 weeks | Change of shoulder flexion and abduction range of motion |
Outcome results
None listed