EFFECTS OF PREOPERATIVE INTENSIVE PULMONARY REHABILITATION FOR A

WEEK ON RESPIRATORY FUNCTION AND EXERCISE CAPACITY OF PATIENTS WITH

LUNG CANCER

Esra PEHLIVAN *

Akif TURNA*, Atilla GURSES*

H. Nilgün GURSES *** Yedikule Chest Disease and Chest Surgery Hospital , Istanbul.

** Istanbul Bilim University, School of Health, Department of Physical Therapy and

     Rehabilitation, Istanbul.

2

Objective

The aim of this study was to investigate the effect of short and intensive preoperative pulmonary rehabilitation, on lung functions and exercise capacity of patients with lung cancer.

3

Methods

January 2007- August 2008 60 patient Prospective, randomized,

controlled

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Inclusion Criteria

Planned to operete with thoracotomy Clinical stage IA to IIIB Detected lung tumour >ASA II or better

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Exclusion Criteria

Severe cardiac diseases,

Severe cognitive problems and phychiatric diseases

Physical limitations

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Algorithm of study

IA-IIIB AC CA

Mdx.

Hospital record number-single Hospital record number-dual

First evaluation (Pre-operative,before rehabilitation)

1 week hospital stay Home

Physical Therapy

Operatation

Post-operative physical therapy

Final evaluation

Pre-operative 2. evaluation

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Method

Parameters; LFTEffort capacity

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Method

Physical therapy Pre-operative stage Post-operative stage

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Pre-operative Physical Therapy and Rehabilitation Breathing exercises İncentive spirometry usage Coughing technics Walking training

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Pre-operative Physical Therapy and Rehabilitation Diaphragmatic Breathing Exercise

Gürses HN, Astımlı hastaların Tedavisinde Fizyoterapi Rehabilitasyon. İn: Gürses HN, Polat MG, editör. Astımla Birlikte Sorunsuz Yaşamak. İstanbul: Türkiye Fizyoterapistler Derneği İstanbul Bölge Temsilciliği Yayını; 1995. pp. 10-25.

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Pre-operative Physical Therapy and Rehabilitation

Pursed Lip Breathing

Gürses HN. KOAH’da Fizyoterapi Rehabilitasyon ve Egzersiz Eğitimi. “KOAH’ta Solunum Rehabilitasyonu” TÜSAD 28. Ulusal Kongresi Antalya. 2006; 59-60.

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Pre-operative Physical Therapy and Rehabilitation

Segmental Breathing Exercise

Ralph Braunschweig. Physical Therapy for The Thoracic Surgical Patient. İn; Shields TW, ed.. General Thoracic Surgery. USA: Williams and Wilkins; 1994. pp. 371-378.

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Pre-operative Physical Therapy and Rehabilitation İncentive spirometry usage

Weiner P. The Effect Of Incentive Spirometry And Inspiratory Muscle Training On Pulmonary Function After Lung Resection. J Thorac Cardiovasc Surg 1997; 113: 552-557.

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Pre-operative Physical Therapy and Rehabilitation

Coughing technics

McCool FD, Rosen MJ. Nonpharmacologic Airway Clearance Therapies: ACCP Evidence-Based Clinical. Practice Guidelines. Chest 2006; 129: 250-259.

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Pre-operative Physical Therapy and Rehabilition

Walking training

Star JA. Choronic Pulmonary Disfunction. İn; O.’Sullivan SB, editör. Physical Rehabilitation Assesment and Treatment . Philadelphia: F.A.Davis Company; 1994. pp. 277-295.

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Pre-operative Physical Therapy and Rehabilitation

Control Group??

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Post-operative Physical Therapy and Rehabilitation Breathing exercises, İncentive spirometry usage, Couphing, Extremity and shoulder girdle exercises, Postür exercises, Positioning, Walking, TENS.

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Results

Study Group

N=30

Control Group

N=30

pmn±sd mn±sd

Age 54.10±8.53 54.76±8.45 0.7

Weight 68.76±10.75 65.20±8.95 0.1

Height 1.68±6.62 1.68±4.67 0.8

BMI(kg/m2) 23.86±3.15 23.24±3.18 0.4

Smoking 46.80±23.55 50.76±26.62 0.5

Table 1 : Demographic characteristics of patients in study and control group.*.

*Independent student t test, ** BMI: Body mass index

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Results

Table 2: Preoperative respiration function parameter of the patients in study and control group-1.*

Study Groupn= 30mn±sd

Control Groupn= 30mn±sd

p

FVCpredicted (L) 3,97±0,45 4,11±0,53 0,2FVCpreop. (L) 2,87±0,59 3,18±0,77 0,08FVCbefore discharge % (L) 72,95±12,51 77,15±15,83 0,2FEV1 predicted (L/sc) 3,21±0,38 3,08±0,37 0,1FEV1 preop. (L/sc) 2,10±0,54 2,38±0,73 0,09FEV1 before discharge % 65,40 ±14,20 77,04±20,01 0,1FEV1/FVC predicted (%) 79,26±2,48 74,33±4,09 0,1FEV1 /FVCpreop. (%) 74,00±11,85 72,40±16,76 0,6FEV1 /FVCbefore discharge % 80,29±9,09 76,12±8,50 0,07PEFpredicted (L/sc) 8,16±0,62 8,13±0,66 0,8PEFpreop. (L/sc) 4,01±1,49 5,24±1,89 0,07PEFbefore discharge % 49,12±17,26 64,56±22,12 0,04

*Independent student t test

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Results

Table 3: Preoperative respiration function parameter of the patients in study and control group-2.*

Study Groupn= 30

mn±sd

Control Groupn= 30

mn±sd p

DLCOpredicted (mmol/k.Pa.sc) 27,30±2.86 27,8±2,60 0,4

DLCOpreop. (mmol/k.Pa.sc) 19,96±7,33 21,30±6,13 0,4

DLCObefore discharge % 71,16±22,54 76,46±21,06 0,3

DLCO/VApredicted (DLCO/L) 4,31±0,23 4.31±0,20 1,0

DLCO/VApreop. (DLCO/L) 4,04±0,94 4,25±0,31 0,2

DLCO/VAbefore discharge % 88,24±18,35 97,65±7,92 0,01

*Independent student t test

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Results Table 4: The pulmonary function parameters measured before

pulmonary physical therapy, operation and before discharge-1.*

Study Groupn= 30mn±sd

Control Groupn= 30mn±sd

p

FVCpredicted (L) 3,97±0.45 4,11±0,53

0,3FVCpreop. (L) 2,87±0.59 3,18±0,77FVCbefore discharge (L) 2,25±0,53 2,58±0,77FEV1 predicted (L/sc) 3,21±0,38 3,08±0,37

0,1FEV1 preop. (L/sc) 2,10±0,54 2,38±0,73FEV1 before discharge (L/sn) 1,70±0,40 2,01±0,59FEV1 /FVCpredicted (%) 79,26±2,48 74,33±4,09

0,3FEV1 /FVCpreop. (%) 74,00±11,85 72,40±16,76FEV1 /FVCbefore discharge (%) 76,76±10,19 77,73±16,51PEFpredicted (L/sc) 8,16±0,62 8.13±0,66

0,9PEFpreop. (L/sc) 4,01±1,49 5,24±1,89PEFbefore discharge (L/sc) 3,73±1,57 4,32±1,42*Covaryans analysis, ** Preop. : preoperative.

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Results Table 5: The pulmonary function parameters measured before

pulmonary physical therapy, operation and before discharge-2.*

Study Groupn= 30

mn±sd

Control Groupn= 30

mn±sd p

DLCOpredicted (mmol/k.Pa.sc) 27,30±2.86 27,8±2,60

0,9DLCOpreop. (mmol/k.Pa.sc) 19,96±7,33 21,30±6,13

DLCObeforedischarge

(mmol/k.Pa.sc)15,05±7,06 16,50±5,48

DLCO/VApredicted (DLCO/L) 4,31±0,23 4,31±0,20

0,9DLCO/VApreop. (DLCO/L) 4,04±0,94 4,25±0,31

DLCO/VAbeforedischarge

(DLCO/L)3.38±1,01 3,86±0,57

*Covaryans analysis, ** Preop. : preoperative.

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Results Table 6: Percentage of postoperative pulmonary

functions decrease in study and control groups.*

Study Groupn =30mn±sd

Control Groupn =30mn±sd

P

FVC (%) 19,26±2,33 16,35±2,40 0,6FEV1 (%) 15,84±2,10 8,92±3,5 0,3

FEV1/FVC (%) 6,58±2,5 6,09±2,4 0,9

PEF (%) 6,4±3,2 9,78±3,5 0,3DLCO (%) 21,89±2,7 19,35±2,48 0,6

DLCO/VA (%) 15,71±4,8 9,02±2,4 0,06

* Independent student t test.

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Results Table 7: The value of study groups’ pulmonary function and arterial

blood gases before and after preoperative pulmonary physical therapy and rehabilitation.*

Before Educationmn±sd

After Educationmn±sd

p

FVC (L) 2,87±0,59 3,10±0,62 0,003

FEV1 (L) 2,10±0,54 2,28±0,63 0,01

FEV1/FVC (%) 74,00±11,85 71,87±17,04 0,5

PEF (L/sc) 4,01±1,49 4,31±1,75 0,2

DLCO (mmol/ k.Pa.sc.) 19,96±7,33 21,03±6,89 p<0,001

DLCO/VA (DLCO/L) 4,04±0,94 4,60±2,87 0,2

*Paired t test.

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Results Tablo 8: Walking heart rates, total walking duration, total walking

distance and maximum speed which were recorded during the first and last walking settings.*

Before Educatiommn±sd

After Education

mn±sdp

Beginning heart rate (pulse/sc) 90,10 ±10,45 90,03 ±9,99 0,9

Final heart rate (pulse/sc) 113,60±11,35 109,10±9,48 0,04

Recovery heart rate (pulse/sc) 102,90±±10,13 100,16±8,32 0,06

Duration (sc) 18,23±7,40 39,66±16,23 p<0,001

Distance (m) 614±415,157 991±534,51 p<0,001

Maximum speed (km/h) 4,03±0,97 4,96±1,15 p<0,001

Borg score 4,25±2,28 3,91±1,52 0,3

*Paired t test.

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Results Table 9: Maximum heart rate, walking heart rate-

percentages during walking education.*

Before Education

mn±sd

After Education

mn±sd

p

Beginnig heart rate54,39±6,35 54,45±7,13

0,9

Final heart rate68,63±7,40 65,9±6,27

0,004

Recovery heart rate62,14±6,41 60,55±6,14

0,07

*Paired t test.

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Brief - 1

Increased pulmonary function .

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Brief - 2

Also had positive effects on effort capacity.

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THANKS…THANKS…