Ianthe Boden , Julie Reeve , Anna Jernås , Linda Denehy , Monika Fagevik Olsén
{"title":"术前物理治疗可预防腹部大手术后肺部并发症：对患者个体数据的荟萃分析。","authors":"Ianthe Boden , Julie Reeve , Anna Jernås , Linda Denehy , Monika Fagevik Olsén","doi":"10.1016/j.jphys.2024.02.012","DOIUrl":null,"url":null,"abstract":"<div><h3>Questions</h3><p>Among patients having elective abdominal surgery, how much does preoperative physiotherapy education with breathing exercise training reduce the incidence of postoperative pulmonary complications (PPCs), hospital length of stay and 12-month mortality? How stable are the treatment effects across different PPC definitions, including pneumonia? How much do the treatment effects on PPC, hospital length of stay and mortality vary within clinically relevant subgroups?</p></div><div><h3>Design</h3><p>Individual participant-level meta-analysis (n = 800) from two randomised controlled trials analysed with multivariable regression.</p></div><div><h3>Participants</h3><p>Adults undergoing major elective abdominal surgery.</p></div><div><h3>Interventions</h3><p>Experimental participants received a single preoperative session with a physiotherapist within 4 weeks of surgery and educated on PPC prevention with breathing exercises and early mobilisation. They were taught breathing exercises and instructed to start them immediately on waking from surgery. The control group received no preoperative or postoperative physiotherapy, or early ambulation alone.</p></div><div><h3>Outcome measures</h3><p>PPC, hospital length of stay and 12-month mortality.</p></div><div><h3>Results</h3><p>Participants who received preoperative physiotherapy had 47% lower odds of developing a PPC (adjusted OR 0.53, 95% CI 0.34 to 0.85). This effect was stable regardless of PPC definition. Effects were greatest in participants who smoked, were aged ≤ 45 years, had abnormal body weight, had multiple comorbidities, or were undergoing bariatric or upper gastrointestinal surgery. Participants having operations ≤ 3 hours in duration were least responsive to preoperative physiotherapy. Participants with multiple comorbidities were more likely to have a shorter hospital stay if provided with preoperative physiotherapy (adjusted MD –3.2 days, 95% CI –6.2 to –0.3). Effects on mortality were uncertain.</p></div><div><h3>Conclusion</h3><p>There is strong evidence to support preoperative physiotherapy in preventing PPCs after elective abdominal surgery.</p></div>","PeriodicalId":49153,"journal":{"name":"Journal of Physiotherapy","volume":null,"pages":null},"PeriodicalIF":9.7000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1836955324000134/pdfft?md5=10f987c1280704d4686c4582a50f0a8d&pid=1-s2.0-S1836955324000134-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Preoperative physiotherapy prevents postoperative pulmonary complications after major abdominal surgery: a meta-analysis of individual patient data\",\"authors\":\"Ianthe Boden , Julie Reeve , Anna Jernås , Linda Denehy , Monika Fagevik Olsén\",\"doi\":\"10.1016/j.jphys.2024.02.012\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Questions</h3><p>Among patients having elective abdominal surgery, how much does preoperative physiotherapy education with breathing exercise training reduce the incidence of postoperative pulmonary complications (PPCs), hospital length of stay and 12-month mortality? How stable are the treatment effects across different PPC definitions, including pneumonia? How much do the treatment effects on PPC, hospital length of stay and mortality vary within clinically relevant subgroups?</p></div><div><h3>Design</h3><p>Individual participant-level meta-analysis (n = 800) from two randomised controlled trials analysed with multivariable regression.</p></div><div><h3>Participants</h3><p>Adults undergoing major elective abdominal surgery.</p></div><div><h3>Interventions</h3><p>Experimental participants received a single preoperative session with a physiotherapist within 4 weeks of surgery and educated on PPC prevention with breathing exercises and early mobilisation. They were taught breathing exercises and instructed to start them immediately on waking from surgery. The control group received no preoperative or postoperative physiotherapy, or early ambulation alone.</p></div><div><h3>Outcome measures</h3><p>PPC, hospital length of stay and 12-month mortality.</p></div><div><h3>Results</h3><p>Participants who received preoperative physiotherapy had 47% lower odds of developing a PPC (adjusted OR 0.53, 95% CI 0.34 to 0.85). This effect was stable regardless of PPC definition. Effects were greatest in participants who smoked, were aged ≤ 45 years, had abnormal body weight, had multiple comorbidities, or were undergoing bariatric or upper gastrointestinal surgery. Participants having operations ≤ 3 hours in duration were least responsive to preoperative physiotherapy. Participants with multiple comorbidities were more likely to have a shorter hospital stay if provided with preoperative physiotherapy (adjusted MD –3.2 days, 95% CI –6.2 to –0.3). Effects on mortality were uncertain.</p></div><div><h3>Conclusion</h3><p>There is strong evidence to support preoperative physiotherapy in preventing PPCs after elective abdominal surgery.</p></div>\",\"PeriodicalId\":49153,\"journal\":{\"name\":\"Journal of Physiotherapy\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":9.7000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S1836955324000134/pdfft?md5=10f987c1280704d4686c4582a50f0a8d&pid=1-s2.0-S1836955324000134-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Physiotherapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1836955324000134\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Physiotherapy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1836955324000134","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Preoperative physiotherapy prevents postoperative pulmonary complications after major abdominal surgery: a meta-analysis of individual patient data
Questions
Among patients having elective abdominal surgery, how much does preoperative physiotherapy education with breathing exercise training reduce the incidence of postoperative pulmonary complications (PPCs), hospital length of stay and 12-month mortality? How stable are the treatment effects across different PPC definitions, including pneumonia? How much do the treatment effects on PPC, hospital length of stay and mortality vary within clinically relevant subgroups?
Design
Individual participant-level meta-analysis (n = 800) from two randomised controlled trials analysed with multivariable regression.
Participants
Adults undergoing major elective abdominal surgery.
Interventions
Experimental participants received a single preoperative session with a physiotherapist within 4 weeks of surgery and educated on PPC prevention with breathing exercises and early mobilisation. They were taught breathing exercises and instructed to start them immediately on waking from surgery. The control group received no preoperative or postoperative physiotherapy, or early ambulation alone.
Outcome measures
PPC, hospital length of stay and 12-month mortality.
Results
Participants who received preoperative physiotherapy had 47% lower odds of developing a PPC (adjusted OR 0.53, 95% CI 0.34 to 0.85). This effect was stable regardless of PPC definition. Effects were greatest in participants who smoked, were aged ≤ 45 years, had abnormal body weight, had multiple comorbidities, or were undergoing bariatric or upper gastrointestinal surgery. Participants having operations ≤ 3 hours in duration were least responsive to preoperative physiotherapy. Participants with multiple comorbidities were more likely to have a shorter hospital stay if provided with preoperative physiotherapy (adjusted MD –3.2 days, 95% CI –6.2 to –0.3). Effects on mortality were uncertain.
Conclusion
There is strong evidence to support preoperative physiotherapy in preventing PPCs after elective abdominal surgery.
期刊介绍：
The Journal of Physiotherapy is the official journal of the Australian Physiotherapy Association. It aims to publish high-quality research with a significant impact on global physiotherapy practice. The journal's vision is to lead the field in supporting clinicians to access, understand, and implement research evidence that will enhance person-centred care. In January 2008, the Journal of Physiotherapy became the first physiotherapy journal to adhere to the ICMJE requirement of registering randomized trials with a recognized Trial Registry. The journal prioritizes systematic reviews, clinical trials, economic analyses, experimental studies, qualitative studies, epidemiological studies, and observational studies. In January 2014, it also became the first core physiotherapy/physical therapy journal to provide free access to editorials and peer-reviewed original research. The Australian Physiotherapy Association extended their support for excellence in physiotherapy practice by sponsoring open access publication of all Journal of Physiotherapy content in 2016. As a result, all past, present, and future journal articles are freely accessible, and there are no author fees for publication.
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