Pulmonary function and physical performance outcomes with preoperative physical therapy in upper abdominal surgery: a randomized controlled trial

Objective: Investigation of the effects of preoperative physical therapy on pulmonary function and physical performance before and after upper abdominal surgery. Design: Non-blind randomized controlled trial. Setting: Tertiary public hospital and private university, SAo Paulo state, Brazil. Subjects: Thirty-two patients undergoing abdominal surgery. Interventions: Patients were randomly assigned to receive physical therapy, with respiratory and global exercises, 2-3 weeks before surgery (treatment group; n = 16) or await operation without engaging in practicing (control group; n = 16). After surgery, a physical therapy protocol was administered to all subjects until the seventh postoperative day. Main measures: Pulmonary function outcome variables were inspiratory and expiratory strength, respiratory muscle endurance and spirometry, and physical performance outcome variables were the functional independence measure and 6-minute walk test distance. Any postoperative pulmonary complications were recorded. Results: There were no between-group differences at randomization. In the preoperative period, patients in the intervention group had higher inspiratory strength and respiratory muscle endurance than controls (88 cmH(2)O versus 64 cmH(2)O and 28 cmH(2)O versus 23 cmH(2)O, respectively; P <0 0.05). On the seventh postoperative day, in addition to inspiratory force and respiratory muscle endurance, the intervention group showed better results than controls in the functional independence measure score (118 versus 95) and 6-minute walk test distance (368.5 m versus 223 m), all P <0 0.05. Postoperative pulmonary complications occurred in 11 patients in the control group and five in the intervention group (P = 0.03). Conclusion: Preoperative physical therapy improved pulmonary function and physical performance in the pre- and postoperative periods among patients undergoing upper abdominal surgery.