Investigating balance, gait, and physical function in people who have undergone thoracic surgery for a diagnosis of lung cancer: A mixed-methods study

Abstract

Objectives Symptoms associated with lung cancer and thoracic surgery might increase fall risk. We aimed to investigate: 1) balance, gait and functional status in people post-thoracic surgery compared to healthy controls; 2) perceptions of balance, gait and functional status. Methods Recruitment targeted older adults (≥50 years) who had undergone thoracic surgery for a diagnosis of lung cancer in the previous 3 months, and healthy age-matched controls. Dynamic and static balance, gait velocity, knee-extension strength and physical activity levels were assessed using the BESTest, Kistler force plate, GAITRite system, Biodex System 3 and CHAMPS questionnaire, respectively. Two-part semi-structured interviews were conducted post-surgery. Results Individuals post-surgery ( n = 15) had worse dynamic balance and gait, and lower levels of moderate/vigorous physical activity (MVPA) (all p<0.05) versus healthy controls ( n = 15). Strength did not differ between groups ( p > 0.05). No associations between BESTest and strength or physical activity existed post-surgery ( p > 0.05). Three themes were identified: 1) Symptoms affect daily activities; 2) Functional assessments alter perceptions of balance ability and 3) Open to supervised rehabilitation. Conclusion Balance, gait and MVPA are impaired post-thoracic surgery, yet balance was not viewed to be important in enabling activities of daily living. However, supervised rehabilitation was considered acceptable.

Rehabilitation pre- and post thoracic surgery: Progress and future opportunities

“…Post-operatively, Tough et al evaluated older adults (≥ 50 years old) who underwent surgical resection for lung cancer in the previous 3-months. 10 When compared to age-matched healthy controls, dynamic balance and gait were affected, including a lower proportion achieving moderate-vigorous physical activity, which may be a consequence of multiple post-operative symptoms such as pain, fatigue, dyspnea, and possibly fear of falling. Interestingly, the majority of participants reported no particular balance impairments or limitations in daily activities during interviews, but were open to attending outpatient rehabilitation.…”

“…8 The authors highlight that following surgical lung cancer resection, patients with COPD are at higher risk of all cause morbidity, including risk of post-operative pneumonia and prolonged air leak, given risk factors such as active smoking, diminished ventilatory reserve, and increased comorbidities. 9 However, the surgical resection for mild-moderate COPD patients did not effect long term survival, once other prognostic surgical factors such as age, smoking history, heart disease, and lung cancer staging were factored into the multivariable model. 9 Post-operatively, Tough et al evaluated older adults (≥ 50 years old) who underwent surgical resection for lung cancer in the previous 3-months.…”

“…9 However, the surgical resection for mild-moderate COPD patients did not effect long term survival, once other prognostic surgical factors such as age, smoking history, heart disease, and lung cancer staging were factored into the multivariable model. 9 Post-operatively, Tough et al evaluated older adults (≥ 50 years old) who underwent surgical resection for lung cancer in the previous 3-months. 10 When compared to agematched healthy controls, dynamic balance and gait were affected, including a lower proportion achieving moderatevigorous physical activity, which may be a consequence of multiple post-operative symptoms such as pain, fatigue, dyspnea, and possibly fear of falling.…”

“… 3 , 4 , 8 Furthermore, functional limitations in balance, gait, and physical activity are highlighted in the early post-operative period. 10 A web-based coaching strategy of physical activity promotion is discussed as one novel strategy in improving physical activity and lifestyle, 11 which is a promising strategy to be explored in the pre- and post-surgical settings.…”

CRD Editor’s corner archive: October-December

“…October 29th, 2021 For people diagnosed with lung cancer, attention quite rightly is focused on rapid assessment and access to curative surgery in eligible candidates. There has been less focus on recovery from surgery but as Tough and colleagues 8 highlight in the journal this month, patients regard this as an important aspect of their treatment journey. The authors also report a high prevalence of impaired balance and reduced daily physical activity following surgery and importantly, conducted a qualitative investigation of patients’ experience of treatment finding that the provision of rehabilitation to assist recovery would be welcomed.…”