Variation in Preoperative and Postoperative Physical Therapist Management of Patients Opting for Elective Abdominal Surgery

Abstract

Background Evidence about the role of physical therapy in perioperative care pathways to improve postoperative outcomes is growing. However, it is unclear whether research findings have been translated into daily practice. Objective The objectives of this study were to describe the current content and between-hospital variability of perioperative physical therapist management for patients undergoing colorectal, hepatic, or pancreatic resection in the Netherlands and to compare currently recommended state-of-the-art physical therapy with self-reported daily clinical physical therapist management. Design This was a cross-sectional survey study. Methods Hospital physical therapists were asked to complete an online survey about pre- and postoperative physical therapy at their hospital. To explore the variability of perioperative physical therapist management between hospitals, frequency variables were clustered to determine the level of uniformity. Latent class analysis was performed to identify clusters of hospitals with certain homogeneous characteristics on a 19-item dichotomous scale. Results Of 82 eligible Dutch hospitals, 65 filled out the survey (79.3%). Preoperative physical therapy was performed in 34 hospitals (54.0%; 2/65 responding hospitals were excluded from the data analysis). Postoperative physical therapy was performed in all responding hospitals, focusing mainly on regaining independent physical functioning. Latent class analysis identified a 3-class model. Hospitals in classes I and II were more likely to provide preoperative physical therapist interventions than hospitals in class III. Limitations The use of self-reported answers can lead to bias. Conclusions There was a wide degree of variability between hospitals regarding pre- and postoperative clinical physical therapist practice for patients opting for major abdominal surgery. Three different classes of daily practice were identified. Further translation of key research findings into clinical physical therapist practice is advised, especially for hospitals in which the physical therapist is not involved preoperatively. Moreover, improving uniformity by developing up-to-date clinical guidelines is recommended.

Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trial

“…The aim of preoperative physiotherapy is to enable a patient to start performing breathing exercises immediately after surgery, rather than the day after surgery, which is normally when the first physiotherapy session provided (Reeve et al 2019 ; van Beijsterveld et al 2019 ). Bringing the time point of these exercises forward a day could also introduce a possible dose-dependent relationship benefit.…”

“…This paper reports associated clinical benefits to signs of airway infection, oxygen therapy use, and antibiotic prescription rates. In developed countries, preoperative physiotherapy is currently not standard practice (Reeve et al 2019 ; van Beijsterveld et al 2019 ). This new evidence, in conjunction with cost-effectiveness (Boden et al 2020 ) and consumer-lead preference for this service (Boden et al 2018b ), may now encourage hospitals to consider embedding a preoperative physiotherapy service within pre-admission clinics for all patients listed for elective upper abdominal surgery.…”

Exploring the relation between preoperative physical functioning and the impact of major complications in patients following pancreatic resection

“…12,13 Moreover, as externalpragmatic clinicalvalidation of available evidence-based risk models is scarce and risk models are thought to not outweigh the surgeon's assessment, they currently play a very limited role in clinical practice. 14,15 Patient's tolerance for surgery depends on their ability to adapt to the stress of hospitalization (e.g. decreased physical activity 16 ) and surgery (e.g.…”