In-hospital physiotherapy improves physical activity level after lung cancer surgery: a randomized controlled trial

Abstract

Objectives Patients undergoing lung cancer surgery are routinely offered physiotherapy. Despite its routine use, effects on postoperative physical recovery have yet not been demonstrated. The aim of this study was to investigate whether physiotherapy could improve postoperative in-hospital physical activity level and physical capacity. Design Single-blind randomized controlled trial. Setting Thoracic surgery department at a University Hospital. Participants Patients undergoing elective thoracic surgery (n = 94) for confirmed or suspected lung cancer were assessed during hospital stay. Intervention Daily physiotherapy, consisting of mobilization, ambulation, shoulder exercises and breathing exercises. The control group received no physiotherapy treatment. Outcomes In-hospital physical activity assessed with the Actigraph GT3X+ accelerometer, six-minute walk test, spirometry and dyspnea scores. Results The treatment group reached significantly more accelerometer counts (2010 (1508) vs 1629 (1146), mean difference 495 [95% CI 44 to 1109]), and steps per hour (49 (47) vs 37 (34), mean difference 14 [95% CI 3 to 30]), compared to the control group, during the first three postoperative days. No significant differences in six-minute walk test (percent of preoperative 71% vs 79%, P = 0.13), spirometry (FEV1 percent of preoperative 69% vs 69%, P = 0.83) or dyspnoea (M-MRC 2 vs 2, P = 0.74) between the groups were found. Conclusions Patients receiving in-hospital physiotherapy showed increased level of physical activity during the first days after lung cancer surgery, compared to an untreated control group. However, no effects on the six-minute walk test or spirometric values were found. The clinical importance of an increased physical activity level during the early postoperative period needs to be further evaluated.Clinical Trial Registration number: NCT01961700.

Clinical guidelines on perioperative management strategies for enhanced recovery after lung surgery

“…Although there have been no confirmed differences between the exercise capacity or lung function of patients who commenced early postoperative physiotherapy protocol and those who started later, patients with operable cancer seem to benefit from early exercise programs in terms of fatigue reduction (97). However, the effect of an increased postoperative activity level in the early postoperative lung surgery must be further evaluated (98).…”

A scoping review of interventions using accelerometers to measure physical activity or sedentary behaviour during hospitalization

“…Of the pre-habilitation trials, the whole-body training program of Au et al 33 reportedly resulted in an early but unsustained difference between groups with more minutes spent physically active on post-operative day 1, whereas participants in the inspiratory muscle training group of Guinan et al 32 were reportedly less active both on post-operative day 1 and over the admission. Intervention group participants reportedly achieved higher daily step counts and/or more time spent active with individualized physiotherapy (for people undergoing thoracic surgery for lung cancer), 42 and with an early mobility bundle 26 or a system change approach (for older adults). 43 In the self-monitoring randomized-trials, feedback by either accelerometry or an activity whiteboard reportedly increased steps/day as compared to control group care, 21,36,39 although this was only for people who underwent laparoscopic (rather than open) abdominal surgery in one study.…”

Special Anesthesiologic Considerations in Robot-Assisted Thoracic Surgery

“…Respiratory Physiotherapy Early patient mobilization is considered important to reduce postoperative pulmonary complications [5••, 6]. However, evidence for efficiency of postoperative patient mobilization is small [54,55]. Ideally, standard mobilization is conducted by the nursing staff on postoperative day (POD) one.…”