Physiotherapy Practice Patterns for Management of Patients Undergoing Thoracic Surgeries in India: A Survey

Abstract

Aim. The aim of the current study is to determine the practice patterns of physiotherapists for patients undergoing thoracic surgeries in India. Materials and Methodology. A cross-sectional survey was conducted across India in which 600 questionnaires were sent in emails to physiotherapists. The questionnaire addressed assessment and treatment techniques of thoracic surgery. Results. A total of 234 completed questionnaires were returned with a response rate of 39%, with the majority of responses received from Telangana, Karnataka, and Andhra Pradesh. More than 90% of the responders practiced physical examination, chest expansion, chest X-ray, ABG analysis, pulmonary function test, and SpO2 (oxygen saturation) as the assessment measures in both the pre- and the postoperative phase. Breathing exercises, incentive spirometry, thoracic expansion exercises, coughing and huffing, positioning, and modified postural drainage are found to be commonly used physiotherapy interventions, both pre- and postoperatively, with a response rate of more than 90%. A response rate of more than 84.6% indicated that patients are made to dangle their lower limbs over the edge of the bed on the 1st postoperative day. Mobilization, such as walking up to a chair, sit to stand exercises, and perambulation within the patient's room, was started on the 2nd postoperative day, as stated by more than 65% of the physiotherapists. Staircase climbing was started on the 5th postoperative day. The most commonly used functional evaluation prior to discharge was 6-minute walk test. This was, in fact, practiced by 77.4% of the physiotherapists in their clinical settings. Conclusion. The most predominantly employed assessment measures included were physical examination, chest expansion, ABG analysis, pulmonary function test, chest X-ray, SpO2 (oxygen saturation), peripheral muscle strength, and cardiopulmonary exercise. The physiotherapy interventions most commonly used were breathing exercises, thoracic expansion exercises, incentive spirometry, and coughing and huffing techniques, in both the pre- and the postoperative phase.

Early mobilization is associated with decreased mechanical ventilation and ICU length of stay following cardiac surgery

“…14 Nevertheless, more patients were mobilized at 48 h post-admission and afterwards with the most commonly used techniques the active limb mobilization and transfer from bed to the chair which are consistent with other protocols. 18,17 Mobilization seemed to be beneficial for improving the outcomes of mechanically ventilated patients as also reported by Ding et al, 19 indicating the initiation of mobilization within 48-72 h of mechanical ventilation. However, there is little evidence on certified protocols and on how best to implement physiotherapy intervention.…”

“…9,10,11 For safety concerns, it has been reported that is safe with an overall cumulative incidence of potential safety events of 2.6% and rare (0.6%) medical consequences. 12 Although there is a growing number of studies about physiotherapy intervention to ICU patients 13,14,7 and in particular after cardiac surgery, 15,16,17 the rates of early mobilization are controversial. There is a variety of physiotherapeutic techniques and time for launching early mobilization.…”

Recovery Pattern in Different Surgical Approaches on Thoracic Enhanced Recovery based Fourteen-Step Protocol in Patients Undergoing Cardio-thoracic Surgery at University Hospital of Nepal

“…Dangling of lower limbs over edge of the bed was done in day one, walking up to chair and sit to stand exercises in day two and staircase climbing by day four. 23 In our study, we noted differences in minimally invasive and invasive approaches after step 6. As walking is commenced from step 6, postoperative pain in invasive approach might have limited progression from this step onwards.…”

Impact of Myocardial Revascularization on the Range of Joint Motion of the Superior and Inferior Members

“…Physical therapy in the postoperative period of surgical procedures with sternotomy or thoracotomy aims at pulmonary reexpansion and mucociliary clearance [9]. In addition, attention should be paid to postural corrections, associated with the presence of the thoracic drain [10] and limitations of ROM, possibly related to the thoracic approach. When analyzing the joint range of motion, it was verified that only in the horizontal abduction of the right shoulder there was no statistically significant reduction (p = 0.08).…”