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Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial


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Boden, I, Skinner, EH, Browning, L, Reeve, J, Anderson, L, Hill, C, Robertson, IK, Story, D and Denehy, L 2018 , 'Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial' , BMJ (Clinical research ed.), vol. 360 , pp. 1-15 , doi: 10.1136/bmj.j5916.

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Objective:To assess the efficacy of a single preoperativephysiotherapy session to reduce postoperativepulmonary complications (PPCs) after upperabdominal surgery.Design:Prospective, pragmatic, multicentre, patient andassessor blinded, parallel group, randomised placebocontrolled superiority trial.Setting:Multidisciplinary preadmission clinics at threetertiary public hospitals in Australia and New Zealand.Participants:441 adults aged 18 years or older who were withinsix weeks of elective major open upper abdominalsurgery were randomly assigned through concealedallocation to receive either an information booklet(n=219; control) or preoperative physiotherapy(n=222; intervention) and followed for 12 months.432 completed the trial.Interventions:Preoperatively, participants received aninformation booklet (control) or an additional 30minute physiotherapy education and breathingexercise training session (intervention). Educationfocused on PPCs and their prevention throughearly ambulation and self directed breathingexercises to be initiated immediately on regainingconsciousness after surgery. Postoperatively, allparticipants received standardised early ambulation,and no additional respiratory physiotherapy wasprovided.Main outcome measures:The primary outcome was a PPC within 14postoperative hospital days assessed daily using theMelbourne group score. Secondary outcomes werehospital acquired pneumonia, length of hospital stay,utilisation of intensive care unit services, and hospitalcosts. Patient reported health related quality of life,physical function, and post-discharge complicationswere measured at six weeks, and all cause mortalitywas measured to 12 months.Results:The incidence of PPCs within 14 postoperativehospital days, including hospital acquiredpneumonia, was halved (adjusted hazard ratio 0.48,95% confidence interval 0.30 to 0.75, P=0.001) inthe intervention group compared with the controlgroup, with an absolute risk reduction of 15% (95%confidence interval 7% to 22%) and a number neededto treat of 7 (95% confidence interval 5 to 14). Nosignificant differences in other secondary outcomeswere detected.Conclusion:In a general population of patients listed for electiveupper abdominal surgery, a 30 minute preoperativephysiotherapy session provided within existinghospital multidisciplinary preadmission clinicshalves the incidence of PPCs and specifically hospitalacquired pneumonia. Further research is required toinvestigate benefits to mortality and length of stay.

Item Type: Article
Authors/Creators:Boden, I and Skinner, EH and Browning, L and Reeve, J and Anderson, L and Hill, C and Robertson, IK and Story, D and Denehy, L
Keywords: Randomised controlled trial; Perioperative pulmonary complications; Patient education; Upper abdominal surgery
Journal or Publication Title: BMJ (Clinical research ed.)
Publisher: British Medical Association
ISSN: 0959-8138
DOI / ID Number: 10.1136/bmj.j5916
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Licensed under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

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