Comparison of the Therapeutic Alliance Indicators according to the Results of the Survey of Cardiosurgical Patients and their Physical Therapists

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The purpose of the study was to investigate the effect of respiratory physical therapy on the level of free fluid in the pleural cavities after cardiac surgery. Materials and methods. The study involved 138 patients. The patients were randomly divided into three groups: control (respiratory physical therapy was limited to cough), group of incentive spirometry (in classes with a physical therapist patients performed additional 3 approaches of 10 breaths through the simulator; they received recommendations for hourly performance of a similar number of cycles of exercise), a group of patients who received additional respiratory physical therapy with positive expiratory pressure in the form of exhalation into a bottle of water through a tube (number of repetitions and recommendations are similar to those received by the previous group). All groups underwent the same protocol of mobilization and use of therapeutic physical exercises in the procedure of therapeutic gymnastics. Performing exercises with breathing simulators began on the 1st postoperative day. Results and discussion. The results of ultrasound examinations of the level of free fluid in the left and right pleural cavities, which were performed according to the postoperative protocol, were studied. The first ultrasound examination, which was analyzed, was performed on the seventh postoperative day, and in the absence of the study on this day, the data of the next study were selected with the registration of the postoperative day number. In addition, the indicators of the final studies of the level of free fluid of the pleural cavities were compared. The position of the patient during the examinations was a sitting one. Analysis of the level of pleural effusion did not establish the benefits of using additional respiratory physical therapy in both groups. The results of studies of the right pleural cavities did not differ in groups of patients, but those of the left ones differed. Conclusion. Pairwise comparison of the groups confirmed the presence of statistically worse results of examinations of the left pleural cavities in the group of incentive spirometry, as well as the absence of statistical differences between the results of the other two groups. The negative effect of incentive spirometry should be confirmed by additional studies, as its effect differed for the results of the left (negative effect) and right (no advantage) pleural cavity

The Effect of Respiratory Physical Therapy on the Lеvel of Free Fluid in Pleural Cavities after Cardiac Surgery

Vitomskyi¹

2021

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The Influence of Respiratory Component on Satisfaction with Physical Therapy after Cardiosurgical Interventions

Vitomskyi¹

2021

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The purpose of the study was to investigate the effect of additional respiratory physical therapy on the level of satisfaction with physical therapy among patients after cardiac surgery. Materials and methods. The study involved 150 patients. The patients were randomly divided into three groups: control (respiratory physical therapy was limited to cough), group of incentive spirometry (in classes with a physical therapist patients performed additional 3 approaches of 10 breaths through the simulator; they received recommendations for hourly performance of a similar number of cycles of exercise), a group of patients who received additional respiratory physical therapy with positive expiratory pressure in the form of exhalation into a bottle of water through a tube (number of repetitions and recommendations are similar to those received by the previous group). All groups underwent the same protocol of mobilization and use of therapeutic physical exercises in the procedure of therapeutic gymnastics. Performing exercises with breathing simulators began on the first postoperative day. Results and discussion. A questionnaire (17 questions) was used to assess the satisfaction with physical therapy. The survey was conducted on the seventh postoperative day. The answers were distributed on a 5-point Likert scale from 1 point to 5 points. The key preoperative indicators and time indicators of surgical interventions of the examined groups did not differ significantly. Analysis of satisfaction with physical therapy revealed a high level in all items of the questionnaire. Statistical differences between the groups were found in only three items of the questionnaire, but they were not related to either the use of equipment or diligence in treatment or the content of physical therapy. The overall score of the questionnaire did not differ in groups according to the Kraskel-Wallis criterion, and Me indicators (25%; 75%) were in the control group – 81 (77; 85) points, in the group of stimulating spirometry – 81 (72; 85) points in the group with positive expiratory pressure – 79 (73; 84) points (χ2 = 4.560; p = 0.102). Conclusion. Additional respiratory physical therapy did not affect the overall satisfaction rate and results of most items of the questionnaire. The differences found in the three items did not indicate any effect of the use of respiratory physical therapy on the level of satisfaction, as higher scores in these items were in the control group. All items in the questionnaire received high scores

The Influence of Approaches to Early Mobilization of Cardiosurgical Patients on the Duration of Hospitalization

Vitomskyi¹,

Vitomska²

2021

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The purpose of the study was to compare the impact of approaches to early mobilization of cardiac surgery patients on the duration of hospitalization. Materials and methods. Early mobilization of patients after cardiac surgery and study of its effectiveness is an important issue of physical therapy. The beginning of the development of cardiac surgery was characterized by the fact that patients after surgery were in the intensive care unit on a bed rest for several days to improve recovery and prevent complications. The benefits of early mobilization were later recognized, and patient verticalization began earlier. The study involved 90 patients (over 18 years old). Patients were divided into two groups. The first group of mobilization (GM1, n = 49) included patients who underwent surgery on Monday or Tuesday, performed standing and if possible walking on the spot on the first postoperative day with a physical therapist. The second group of mobilization (GM2, n = 41) included patients who underwent surgery on Friday, were mobilized to sit in bed on the first postoperative day; performed standing and walking on the spot on the second or third postoperative day with the participation of medical staff. In addition, other early mobilization points (chamber walking and corridor walking) were performed statistically later in GM2. Patients did not differ in other features of physical therapy. All patients were told during the preoperative consultation with a physical therapist that if they were operated on Friday, they would perform mobilization and therapeutic exercises with medical staff on weekends. Patient case data (age, sex, study protocols and operations) were studied. Results and discussion. Among GM1 patients, the part of men was 69.39%, and in the GM2 group – 78.05% (χ² = 0.856; p = 0.355). Groups of patients did not have significant differences in age, anatropometric parameters, key results of preoperative studies, characteristics of surgical interventions. The study did not establish the effect of more progressive early mobilization performed in GM1 on the length of stay in the postoperative ward (7 (6; 8) nights versus 7 (5; 8) nights; p=0.428) and the total duration of postoperative hospitalization (9 (8; 10) nights against 10 (7; 11) nights; p=0.733). Statistically better indicators of the GM1 group were obtained in the number of nights spent in intensive care (all patients – two nights, except 3 patients in GM1 and 11 in GM2 – three nights; p=0.007), but this advantage should be considered taking into account the impact of patient logistics, namely longer stay in intensive care on weekends. Conclusion. The data confirmed the same effectiveness of approaches to early mobilization of cardiac surgery patients in terms of duration of postoperative hospitalization