The Effect of Mirror Therapy After Thoracotomy
Condition: Post-thoracotomy Pain Syndrome; Shoulder Pain
MeSH terms: Shoulder Pain
Study type: Interventional

Summary: 
      After thoracotomy, limitation in shoulder functions, ipsilateral shoulder pain, decrease in
      shoulder muscle strength and deterioration in quality of life occur. The exercise program
      applied after thoracotomy includes active range of motion exercises, postural correction
      activities, scapular strengthening exercises, and stretching of the chest and shoulder
      muscles. Mirror therapy can improve motor functions and reduce unilateral pain. This study
      aims to evaluate the effects of upper extremity exercises based on mirror therapy after
      thoracotomy on ipsilateral shoulder pain, shoulder joint range of motion, shoulder muscle
      strength, shoulder function, quality of life, movement and fear of re-injury. The patients
      were divided into 2 groups as "mirror therapy group" and "control group", by choosing a
      simple randomization so that they could not see what was written on their pre-prepared
      papers. Standard medical treatment, care and pulmonary rehabilitation program were applied to
      both groups. In addition to the routine rehabilitation program after thoracotomy, the study
      group received a total of 24 sessions of foal therapy, 3 sessions a week, for 8 weeks. Data
      were collected using the Personal Information Form including the demographic characteristics
      of the patients, Tampa Kinesiophobia Scale, Numerical Pain Rating Scale (NPRS), Shoulder
      Active Range of Motion, Pain Catastrophization Scale, Shoulder Pain and Disability Index,
      Shoulder muscle strength, SF-12. performed before and after treatment.
    

Detailed description: 
      Mirror therapy can improve motor functions and reduce unilateral pain. A Mirror therapy
      applied to patients with shoulder pain and limited shoulder joint range of motion reduces
      pain intensity, improves active joint range of motion and shoulder functions, and improves
      kinesiophobia levels. The exercise program applied after thoracotomy includes active range of
      motion exercises, postural correction activities, scapular strengthening exercises, and
      stretching of the chest and shoulder muscles. Verbal and tactile cues may be required to
      complete these exercises. Therefore, mirror therapy can be a helpful tool that provides
      visual feedback while performing these exercises. This study aims to evaluate the effects of
      mirror therapy-based upper extremity exercises on ipsilateral shoulder pain, shoulder joint
      range of motion, shoulder muscle strength, shoulder function, quality of life, movement and
      fear of re-injury. This study, which was planned as a prospective randomized controlled
      study; It was performed on patients aged 25-65 years who were admitted to the Akdeniz
      University Hospital Thoracic Surgery Clinic underwent lung resection (lobectomy,
      segmentectomy or wedge resection) with standard posterolateral thoracotomy. PS Power and
      Sample Size Calculations Version 3.0 program was used for sample size calculation. The study
      titled "The effect of interscalene block on ipsilateral shoulder pain and pulmonary function
      in patients undergoing lung lobectomy: A randomized controlled trial" by Woo et al. In this
      direction, the targeted number of patients in the sample was planned as 70 patients, of which
      at least 35 were controls. The necessary permissions were obtained and the study was carried
      out at the Akdeniz University Hospital Thoracic Surgery Clinic. The information form prepared
      in accordance with the standards of the Akdeniz University Faculty of Medicine Clinical
      Research Ethics Committee and the voluntary consent form were signed by all cases.
      Demographic data of the cases were recorded on the "Patient Evaluation Form" created by us.
      In the preoperative period, the age, gender, weight and height measurements, educational
      status, type of surgery, whether there was any additional systemic disease, smoking, alcohol
      habits, medications that they constantly used, and previous operations were recorded in both
      groups. The patients were divided into 2 groups as "study" and "control group", by choosing a
      simple randomization so that they could not see what was written on their pre-prepared
      papers. Standard medical treatment, care and pulmonary rehabilitation program were applied to
      both groups. Patients were mobilized as early as possible. The control group consisted of
      patients who underwent thoracotomy and underwent routine rehabilitation in the post-surgical
      period. routine respiratory rehabilitation program; It consists of a) positioning, b) general
      body exercises, c) airway clearance techniques, d) breathing exercises, e) incentive
      spirometry and f) mobilization applications. In this study, the study group consisted of
      patients who would receive mirror therapy in addition to the routine rehabilitation program
      described above and applied to the control group in the post-thoracotomy period. In the study
      group, mirror therapy was started with the permission of the responsible doctor after the
      patient was extubated during the surgical period, that is, after he was awakened from
      anesthesia and after he became fully conscious and his hemodynamic status stabilized. To be
      applied in addition to the standard treatment, the study group was placed in such a way that
      the mirror was in the midline of the body and it was ensured that the healthy extremity could
      be seen on the reflected face of the mirror, and the patient's extremity would not be seen by
      leaving it behind the mirror. In this position, first, symmetrical movements were performed
      for 1-2 minutes to understand the mirror effect, then active shoulder flexion, abduction, and
      rotation movements were performed bilaterally, each with 15 repetitions.The patients received
      treatment for 8 weeks, 3 sessions a week, for a total of 24 sessions. Each treatment session
      lasts between 60 and 90 minutes. Evaluations were made before and after treatment.

      Data, Personal Information Form including demographic characteristics of patients, Numerical
      Pain Rating Scale (NPRS), Shoulder Active Range of Motion, Shoulder Muscle Strength, Shoulder
      Pain and Disability Index (SPADI), Short Form 12 (SF-12), Tampa Kinesiophobia Scale, It was
      collected using the Pain Catastrophe Scale (PCS).
    

Intervention name(s): Mirror therapy
Intervention type(s): Device
Intervention description(s): The patients received a total of 24 sessions of treatment for 8 weeks, 3 sessions a week, starting from the postoperative 1st day after thorakaotomy. Each treatment session lasts between 60 and 90 minutes.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention