Postoperative physiotherapy has been shown to reduce the incidence of postoperative pulmonary complications after open abdominal surgery. This study aimed to determine if the addition of deep breathing exercises and secretion clearing techniques to a standardised physiotherapist-directed program of early mobilisation improved clinical outcomes in patients undergoing open abdominal surgery. Fifty-six patients undergoing open abdominal surgery, at high risk of developing postoperative pulmonary complications, were randomised before operation to an early mobilisation-only group or an early mobilisation-plus-deep breathing and coughing group. Mobility duration, frequency and intensity of breathing interventions were quantified for both groups. All outcomes were assessed by a blinded outcomes researcher using a standardised outcomes measurement tool developed specifically for this population. Outcomes included incidence of clinically significant postoperative pulmonary complications, fever, length of stay, and restoration of mobility. There were no significant differences between groups in mean age, anaesthetic time, perioperative morbidity, or postoperative mobility. Outcome data were available for 89% of enrolled subjects. Overall incidence of postoperative pulmonary complications was 16%. The incidence of postoperative pulmonary complications in the non-deep breathing and coughing group was 14%, and the incidence of postoperative pulmonary complications in the deep breathing and coughing group was 17%, (absolute risk reduction -3%, 95% C1 -22 to 19%). There was no significant difference between groups in the incidence of fever, physiotherapist time, or the number of treatments. This study suggests that, in this clinical setting, the addition of deep breathing and coughing exercises to a physiotherapist-directed program of early mobilisation does not significantly reduce the incidence of clinically significant postoperative pulmonary complications in high risk open abdominal surgery subjects.

Pulmonary rehabilitation programs in Australia generally meet the broad recommendations for practice in terms of components, program length, assessment and exercise training. The prescription of exercise training intensity is an area requiring deeper exploration.

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Background Sternal precautions are utilized within many hospitals with the aim of preventing the occurrence of sternal complications (eg, infection, wound breakdown) following midline sternotomy. The evidence base for sternal precaution protocols, however, has been questioned due to a paucity of research, unknown effect on patient outcomes, and possible discrepancies in pattern of use among institutions. Objective The objective of this study was to investigate and document the use of sternal precautions by physical therapists in the treatment of patients following median sternotomy in hospitals throughout Australia, from immediately postsurgery to discharge from the hospital. Design A cross-sectional, observational design was used. An anonymous, Web-based survey was custom designed for use in the study. Methods The questionnaire was content validated, and the online functionality was assessed. The senior cardiothoracic physical therapist from each hospital identified as currently performing cardiothoracic surgery (N=51) was invited to participate. Results The response rate was 58.8% (n=30). Both public (n=18) and private (n=12) hospitals in all states of Australia were represented. Management protocols reported by participants included wound support (n=22), restrictions on lifting and transfers (n=23), and restrictions on mobility aid use (n=15). Factors influencing clinical practice most commonly included “workplace practices/protocols” (n=27) and “clinical experience” (n=22). Limitations The study may be limited by response bias. Conclusions Significant variation exists in the sternal precautions and protocols used in the treatment of patients following median sternotomy in Australian hospitals. Further research is needed to investigate whether the restrictions and precautions used are necessary and whether protocols have an impact on patient outcomes, including rates of recovery and length of stay.