Addressing the changing rehabilitation needs of patients undergoing thoracic surgery

Abstract

The rehabilitation needs of individuals undergoing thoracic surgery are changing, especially as surgical management is increasingly being offered to patients who are at risk of developing functional limitations during and after hospital discharge. In the past rehabilitative management of these patients was frequently limited to specific respiratory physiotherapy interventions in the immediate postoperative setting with the aim to prevent postoperative pulmonary complications. In the past two decades, this focus has shifted toward pulmonary rehabilitation interventions that aim to improve functional status of individuals, both in the pre- and (longer-term) postoperative period. While there is increased interest in (p)rehabilitation interventions the majority of thoracic surgery patients are however currently on their own with respect to progression of their exercise and physical activity regimens after they have been discharged from hospital. There are also no formal guidelines supporting the referral of these patients to outpatient rehabilitation programs. The current evidence regarding rehabilitation interventions initiated before, during, and after the hospitalization period will be briefly reviewed with special focus on patients undergoing surgery for lung cancer treatment and patients undergoing lung transplantation. More research will be necessary in the coming years to modify or change clinical rehabilitation practice beyond the acute admission phase in patients undergoing thoracic surgery. Tele rehabilitation or web-based activity counseling programs might also be interesting emerging alternatives in the (long-term) postoperative rehabilitative treatment of these patients.

Feasibility and acceptability of a physical activity behavioural modification tele-coaching intervention in lung transplant recipients

“…Literature on interventions to improve physical activity in LTx recipients is scarce. 2 Improvements in daily steps in the current study exceeded those shown following exercise training. 10 , 38 This is likely due to step counts being the central focus of the intervention and the incorporation of behavioural techniques such as self-monitoring, goal setting and feedback, which have been deemed important for enhancing healthy activity behaviours.…”

“… 1 In addition to increasing survival, an important goal of LTx is to enhance health-related quality of life (HRQoL) and physical function. 2 Despite improvements in lung function, significant skeletal muscle weakness and reduced exercise capacity persist after LTx, which may limit improvements in daily physical functioning and HRQoL. 3 This is due to a host of factors including deconditioning as a result of persistent sedentary time, as well as immunosuppressant medications and episodes of organ rejection which may hinder functional recovery.…”

Rehabilitation pre- and post thoracic surgery: Progress and future opportunities

“…A narrative review by Daniel Langer summarizes the landscape of rehabilitation in thoracic surgery focusing on interventions that aim to optimize physical function pre-operatively and recovery in the post-operative period. 3 This review highlights that the majority of the evidence is in the areas of thoracic oncology and lung transplantation. It also reinforces that rehabilitation programs can be beneficial in improving skeletal muscle function, exercise capacity, quality of life, and functional recovery, but there remains a lack of guidelines with respect to training regimens, duration and referral pathways.…”

“… 6 Pre-operative physical function can help with earlier post-operative mobilization, improved airway clearance and ventilatory mechanics that can help reduce postoperative pulmonary complications. 3 , 7 …”

“…The articles reinforce the importance of pre-operative physical function and COPD management in reducing the risk of peri-operative pulmonary complications. 3 , 4 , 8 Furthermore, functional limitations in balance, gait, and physical activity are highlighted in the early post-operative period. 10 A web-based coaching strategy of physical activity promotion is discussed as one novel strategy in improving physical activity and lifestyle, 11 which is a promising strategy to be explored in the pre- and post-surgical settings.…”