BackgroundGiven the extent of the surgical indications for pulmonary lobectomy in breathless patients, preoperative care and evaluation of pulmonary function are increasingly necessary. The aim of this study was to assess the contribution of preoperative pulmonary rehabilitation (PR) for reducing the incidence of postoperative pulmonary complications in non‐small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD).MethodsThe records of 116 patients with COPD, including 51 patients who received PR, were retrospectively analyzed. Pulmonary function testing, including slow vital capacity (VC) and forced expiratory volume in one second (FEV
1), was obtained preoperatively, after PR, and at one and six months postoperatively. The recovery rate of postoperative pulmonary function was standardized for functional loss associated with the different resected lung volumes. Propensity score analysis generated matched pairs of 31 patients divided into PR and non‐PR groups.ResultsThe PR period was 18.7 ± 12.7 days in COPD patients. Preoperative pulmonary function was significantly improved after PR (VC 5.3%, FEV
1 5.5%; P < 0.05). The FEV
1 recovery rate one month after surgery was significantly better in the PR (101.6%; P < 0.001) than in the non‐PR group (93.9%). In logistic regression analysis, predicted postoperative FEV
1, predicted postoperative %FEV
1, and PR were independent factors related to postoperative pulmonary complications after pulmonary lobectomy (odds ratio 18.9, 16.1, and 13.9, respectively; P < 0.05).Conclusions
PR improved the recovery rate of pulmonary function after lobectomy in the early period, and may decrease postoperative pulmonary complications.
Occupational therapy did not adequately relieve resting or motion pain, but all patients achieved independence in activities of daily living and housekeeping activities. Although occupational therapy significantly improved shoulder elevation for all movements, shoulder elevation was significantly better for flexion than for active and passive abduction.
In this study, we constructed a novel three-dimensional trunk musculoskeletal model that included thoracolumbar intervertebral using data from computed tomography (CT) and magnetic resonance imaging (MRI). Characteristics of the model are as follows. Firstly, the thoracolumbar structure was modeled in detail (i.e., skeleton,muscle paths and muscle cross-section areas) from CT and MRI data. Secondly, new factors were included in this model such as intra-abdominal pressure and physiological trunk range of motion to calculate internal biological forces more accurately than in previous models. Thirdly, this musculoskeletal trunk model is an aid to analyzing dynamic motion. The aims of this study was to analyze detailed three-dimensional motion in healthy adults using this model, and to estimate internal biological forces, including spinal moment and muscle force in a standing position. The validation of this model used the calculated intradiscal pressure for the L4/L5 disc according to previous reports. This model is able to analyze spinal moments and trunk muscle force during static motions. The present study confirms that the moment curve of spinal can be generalized in the various postures. The model has been validated, and was able to analyze three-dimensional motion (i.e., combinational factors of rotation and flexion). As a result, this model is expected to have clinical applications.
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