A randomized trial comparing inspiratory training and positive pressure training in immediate lung recovery after minor pleuro-pulmonary surgery

Cancer survivor inspiratory muscle training: systematic review and Bayesian meta-analysis

BACKGROUND

The long-term impact of cancer treatment is associated with respiratory dysfunction and physical fitness impairment. Although inspiratory muscle training (IMT) has been shown as an effective exercise therapy in cancer survivors, there is no evidence on the optimal dose, application moment nor specific population effects of this intervention. The main objective of this meta-analysis is to analyse the effects of IMT on pulmonary function, physical fitness and quality of life (QoL) in cancer survivors.

METHODS

This systematic review and meta-analysis was preregistered in the International Prospective Register of Systematic Reviews (PROSPERO) register and conducted according to the Preferred Reporting for Systematic Reviews and Meta-analysis statement. We used a Bayesian multilevel random-effects meta-analysis model to pool the data. Multilevel metaregression models were used to examine the conditional effects of our covariates. Convergence and model fit were evaluated through specific model parameters. Sensitivity analyses removing influential cases and using a frequentist approach were carried out.

RESULTS

Pooled data showed that IMT intervention is effective to improve pulmonary function (standardised mean difference=0.53, 95% credible interval 0.13 to 0.94, SE=0.19). However, IMT did not present statistically significant results on physical fitness and QoL. Metaregression analyses found that the type of cancer, the moment of application and the evaluation tool used had significant moderation effects on pulmonary function.

CONCLUSION

IMT could be an important part in the management of side effects suffered by cancer survivors. Considering the current evidence, this intervention is highly recommended in patients diagnosed with oesophageal and lung cancers. IMT may provide superior benefits before the biological treatment and after the surgery.

PROSPERO REGISTRATION NUMBER

304909.

Prehabilitation: a narrative review focused on exercise therapy for the prevention of postoperative pulmonary complications following lung resection

Extensive preventive strategies in the perioperative period are popular worldwide. Novel "prehabilitation" approaches are being defined for every individual surgical discipline. With intention to reduce perioperative morbidity, "prehabilitation" was developed to increase "physical wellness" considering exercise capacity, nutritional status, and psychological support. Thus, prehabilitation could be well-suited for patients undergoing lung cancer surgery. Theoretically, improving physical condition may increase the chances of having a better post-operative course, especially among frail patients. In this review, we describe the concept of prehabilitation with possible benefits, its role in the Enhanced Recovery After Surgery protocols, and its potential for the future.

Physiotherapy provided for patients undergoing thoracic surgery in Sweden - a national survey of practice

INTRODUCTION

Patients undergoing thoracic surgery commonly receive perioperative physio-therapy, typically consisting of education, mobilization, breathing exercises, and mobility exercises. To date, no study has described physiotherapy practice for patients undergoing thoracic surgery in Sweden.

PURPOSE

To investigate physiotherapy interventions for patients undergoing thoracic surgery in Sweden.

METHODS

All physiotherapists currently working in thoracic surgery units in Sweden (n = 8) were eligible to participate. A survey was e-mailed to the physiotherapists, to determine physiotherapy interventions offered to patients undergoing thoracoscopy or open thoracic surgery. Of 21 physiotherapists, 13 (62%) responded, representing seven hospitals.

RESULTS

Physiotherapists reported routinely providing preoperative education and postoperative treatment for all patients undergoing thoracic surgery. Breathing exercises and mobilization were usually initiated on the day of surgery or the first postoperative day. Common treatments were deep breathing exercises, with or without positive expiratory pressure, and airway clearance techniques. Upper limb and shoulder exercises were typically initiated on the first or second day after surgery. The most important factor reported to influence treatment choice was personal experience of the attending physiotherapist. No routine post-discharge rehabilitation was provided.

CONCLUSION

Physiotherapists in Sweden reported routinely treating patients scheduled for thoracic surgery, both pre and postoperatively. Prehabilitation or post-discharge rehabilitation was not routinely provided.