Appendix V

Pulmonary care program based on evidence from recent research

Study: Effects of perioperative respiratory rehabilitation in lung cancer

resection: a pilot study.

Authors:
Antonella et al., 2020.
Intervention/Aim:
Intervention included deep and slow breathing and mobilization
exercises for thorax. The aim was to evaluate the impact of short
term Preoperative Respiratory Rehabilitation (PRR) on the changes
of respiratory functions and clinical conditions in patients with
malignant lung cancer lesion and reduced respiratory functions, with
high risk to develop postoperative pulmonary complications (PPCs).
Method/Results:
A total of 15 patients were treated with PRR protocol. They showed
a statistically significant improvement of lung functionality Forced
Vital Capacity (FVC), Forced Expiration Value in the first second
(FEV1), walking distance, Partial Oxygen Saturation (SpO2) and
Hart Rate (HR).
Conclusions:
A short feasible PRR is suitable in patients’ candidate to thoracic
surgery.
Study: Is respiratory physiotherapy effective on pulmonary complications
after lobectomy for lung cancer?

Authors: Cinar et al., 2020.

Intervention/Aim: Intervention included deep breathing, coughing and huffing

exercises, early ambulation and progressive mobility exercises for
shoulder girdle and thoracic cage. The aim was to investigate the
effects of a postoperative respiratory physiotherapy program on
pulmonary complications, length of hospital stay and hospital cost
after lobectomy for lung cancer.

The patients were divided into two groups as Group S who received

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 Appendix V
Method/Results: standard postoperative care (n=50) and Group P who received
postoperative respiratory physiotherapy in addition to standard care
(n=40). The multivariate logistic regression analysis showed that
respiratory physiotherapy had a protective effect on the development
of postoperative pulmonary complications.

An intensive physiotherapy program focusing on respiratory

Conclusions: exercises is a cost-effective practice which reduces the risk of
development of postoperative pulmonary complications in patients
undergoing lobectomy for lung cancer.
Study: In-hospital physiotherapy improves physical activity level after lung
cancer surgery: a randomized controlled trial.

Authors: Jonsson et al., 2019.

Intervention/Aim: Daily physiotherapy consisted of mobilization, shoulder and

breathing exercises only for the study group. The aim of this study
was to investigate whether physiotherapy could improve
postoperative in-hospital physical activity level and physical
capacity.

Method/Results: The treatment group reached significantly more accelerometer counts

and steps per hour compared to the control group during the first
three postoperative days. No significant differences in six-minute
walk test, or dyspnea 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.
Study: The Impact of Chest Physiotherapy Technique (CPT) on Respiration,
Pain and Quality of Life Post Thoracic Wall Fixation Surgery among
Flail Chest Patients (FC).

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 Appendix V
Authors: Mohamed et al., 2018.

Intervention/Aim:
Chest physiotherapy included breathing and coughing exercises,
percussion and vibration, incentive spirometry and intermittent
pressure breathing (IPPV). The aim was to assess the impact of chest
physiotherapy technique on respiration, pain and quality of life post
thoracic wall fixation surgery in flail chest patients.
Method/Results:
There was decrease in pain intensity with significant improvement in
quality of life and all outcomes parameter as pulmonary function test
Conclusions: (PFT) and ABGs in the late follow-up.

It concluded that post-operative physiotherapy is therefore

indispensable and helps to bring back the patient to the optimum
normal condition.
Study: Effect of Educational Nursing Protocol on minimizing Patients’
complications after thoracoscopic surgery.

Authors: Nafady et al., 2019.

Intervention/Aim: Spirometer, breathing and coughing exercises, foot and leg exercises,
hand and shoulder exercises for the study group. The aim was to
assess the effect of educational nursing protocol on minimizing
patients' complications after thoracoscopic surgery.

Method/Results: There was high statistically significance difference between study

group patients pretest and posttest in total knowledge and practice
after protocol implementation and no statistical significance
difference between both groups as regard complications.
Conclusions: There were improvements in total knowledge and practice after
protocol implementation. Wound infection and pain were the only
complications happened and with higher percentages in control

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 Appendix V
group than study group.
Study: Effects of Preoperative Breathing Exercise on Postoperative
Outcomes for Patients with Lung Cancer Undergoing Curative Intent
Lung Resection: A Meta-analysis.

Authors: Pu et al., 2021.

Intervention/Aim: Intervention included preoperative inspiratory muscle training (IMT)

and/or breathing exercises. The aim was to determine the benefits of
preoperative breathing exercises on hospital length of stay (LOS),
postoperative pulmonary complications (PPC), 6-minute walk
distance (6MWD), forced expiratory volume in 1 second (FEV1), and
health-related quality of life (HRQOL) in patients undergoing
surgical lung cancer resection.
Method/Results: Preoperative breathing exercises reduced pneumonia and PPCs. An
increase in 6MWD was noted in those performing breathing
exercises. No significant differences were noted in FEV 1, mortality,
or HRQOL.
Conclusions: Preoperative breathing exercises reduced LOS, PPC, and pneumonia
and potentially improved 6MWD in patients undergoing surgical
lung cancer resection. Breathing exercises in combination with
aerobic exercise yielded greater reductions in LOS.