Impact of Preoperative Counselling on Early Postoperative Mobilization and Its Role in Smooth Recovery

Abstract

Background and Objectives. Preoperative counseling is effective to foster early postoperative mobilization that reduces pulmonary complications following abdominal surgery. This study aims at evaluating the effect of preoperative counseling regarding postoperative mobilization and its impact on reducing pulmonary complications. Design and Setting. Randomized control trial was conducted at the Department of Surgery of a tertiary care hospital, Karachi. Patients and Materials. Patients who underwent abdominal surgery and met inclusion criteria were recruited. All participants were randomly divided into two groups. Both groups received information about the surgery and Group I received additional counseling for postoperative mobilization. All patients were encouraged for postoperative mobilization. Scholes et al. criteria were used to evaluate postoperative pulmonary complications. Results. In total 232 participants were recruited and divided into two groups. There was no significant difference in participants' age (P = 0.79), duration of surgery (P = 0.5), and pain score (P = 0.1) of both groups. However, significant difference was identified in mobilization from bed to chair and mobilization for >10 minutes. Patients in Group I experienced less pulmonary complications in comparison with Group II.

The physiotherapy management of patients undergoing abdominal surgery

“…It may not be how much physiotherapy that is important, but rather, when that physiotherapy is provided. The current weight of evidence appears to support the provision of a single preoperative physiotherapy education and DB&C training to all patients having abdominal surgery (Bourn et al 1991, Condie et al 1993, Denehy 2001, Fagevik Olsén et al 1997, Samnani et al 2014. Given the limitations of this research and the low incidence of PPCs following laparoscopic and LAS surgery, the authors recommend the provision of preoperative physiotherapy for all open UAS patients only.…”

“…The control group received no pre or postoperative physiotherapy. (Samnani et al 2014) of 232 abdominal surgery patients again demonstrated a significant reduction in PPCs from 30% to 7% (ARR 22%, 95%CI 13%-32%) when preoperative education focused on the importance of postoperative early ambulation compared to no education at all. Both groups were provided with similar postoperative care.…”

“…Evidence from six clinical trials (Bourn et al 1991, Castillo and Haas 1985, Condie et al 1993, Denehy 2001, Fagevik Olsén et al 1997, Samnani et al 2014 suggests that a single preoperative physiotherapy session significantly reduces PPC rates. In the largest RCT (n=368, PEDro 5/10) the intervention group received a single preoperative physiotherapy education and training session and a single postoperative review of taught breathing exercises (Fagevik Olsén et al 1997).…”

“…Since the 2006 publication of these systematic reviews (Lawrence et al 2006, Pasquina et al 2006, seven additional RCTs have been published (Baltieri et al 2014, Barbalho-Moulim et al 2011, Dronkers 2008, Kulkarni et al 2010, Samnani et al 2014, Zhang et al 2015. The findings of these further studies are summarised in Table 3 and the results and context of the findings are discussed elsewhere in this paper where appropriate.…”

The Investigation Of Mobilization Times Of Patients after Surgery

“…The key recommendations of the ERAS guideline comprise preoperative patient information and counseling, no oral bowel preparation, no preoperative fasting, preoperative carbohydrate loading, no preanaesthetic medication, single dose antibiotic prophylax half an ______________________________ *Correspondence Yasemin Altınbaş Research Assistant Doctor,Department of Nursing, Adıyaman University School of Health, Adıyaman, Turkey E-Mail: yaltinbas@adiyaman.edu.tr hour before surgery, short incisions, avoidance of long acting opioids, mid-thoracic epidural anesthesia, paracetamol as baseline analgesic, avoidance of fluid overload, use of an upper-body forced-air heating cover, no drains, nonaso gastric decompression tubes, prevention of postoperative nausea and vomiting of high risk patients, standard laxatives, early removal of urinary bladder catheters, early oral nutrition and nutritional supplements and early mobilization [1,[5][6][7].Anesthesia, wounds, drains and pain are the inevitable results of surgical procedures and subordinates the patients to stay in bed for short or long periods and prevents patient's mobilization [7,8]. When the patients are not mobilized insulin resistance increases, muscles get weakened and muscle weight decreases.…”