The Impacts of Pulmonary Rehabilitation Therapy on Patients After Thoracic Surgery
Condition: Lung Neoplasms
MeSH terms: Lung Neoplasms
Study type: Interventional

Summary: 
      The advantages of thoracoscopic surgery include smaller wounds, fewer postoperative
      complications, and shortened hospital stay. However,complications such as pain, pulmonary
      function insufficiency, pneumonia,postoperative pneumothorax, persistent air leakage,
      subcutaneous emphysema, cough, and hemoptysis may occur in older patients after thoracoscopic
      surgery. Pulmonary rehabilitation has been demonstrated by evidence-base medicine could
      effectively reduce pulmonary complications and dyspnea as well as improve lung function,
      quality of life, exercise ability, and functional status of patients after traditional heart
      and thoracic surgery. Studies have suggested that pulmonary rehabilitation should be
      performed for at least 4 weeks to optimize the training effect .However, most patients who
      undergo thoracoscopic surgery were discharged within 3-5 days. Such a short hospital stay
      impeded the delivery of pulmonary rehabilitation. Home-based pulmonary rehabilitation
      appeared to be an option for these patients The purpose of this study is to determine whether
      Pulmonary rehabilitation are effective on patients who had thoracic surgeries.
    

Detailed description: 
      Pulmonary-related surgeries remain some potential risks according to the previous
      evidence-based studies. Particularly, individuals who were over 65 years of age with smoking,
      chronic pulmonary disease, wheezy, cardiovascular comorbidities, upper respiratory infection
      were at the high risk of pulmonary complications after surgery,which accounted for
      approximately 2% to 40% of occurrence rate. The average mortality rate due to surgery was
      approximately 2%-8% in patients aged more than 65 years.Pulmonary rehabilitation could
      effectively reduce pulmonary complications and dyspnea as well as improve lung function,
      quality of life, exercise ability, and functional status of patients after traditional heart
      and thoracic surgery.But efficacy of home-based pulmonary rehabilitation for older adults
      following thoracoscopic surgery, it has not received much attention.

      This study employed a prospective, randomized, and controlled clinical design to determine
      the efficacy of home-based pulmonary rehabilitation in older adults after VATS. All
      participants underwent preoperative and initial postoperative pulmonary rehabilitation during
      their hospital stay and were randomly assigned to the experimental or control group at the
      time of discharge. The control group received standard health education, whereas the
      experimental group received home-based pulmonary rehabilitation in addition to standard
      health education. Objective and personal subjective outcome measurements were performed
      before hospital discharge and 2, 6, and 12 weeks after discharge The control group received
      standard care. Considering the principle for exercise progression, we divided the home-based
      rehabilitation program into two stages (0-2 weeks and 3-6 weeks).The exercise program was
      adjusted in the second week when patients visited the outpatient department of the hospital
      for follow-up. The home-based rehabilitation program included (1) breathing exercises
      (pursed-lip and diaphragmatic breathing) and coughing exercises, (2) aerobic exercises (upper
      and lower limb exercises and walking), (3) incentive spirometry training (Triflo-II), and (4)
      threshold load training of the inspiratory muscle. In the first stage (0-2 weeks), the
      aerobic exercise intensity was targeted to reach 10-11 points on the 20-point Borg rating of
      perceived exercise (RPE) scale. Patients raised their upper limbs while simultaneously
      performing lower-limb stepping at place for 20 min; in addition, they walked at a comfortable
      speed for 15 min twice per day. Incentive spirometry training (Triflo-II) was performed 8-10
      times per hour. We used a threshold load trainer for inspiratory muscle training (30 breaths
      each time, twice per day) with the initial pressure set at 25%-30% of the maximum inspiratory
      pressure.

      In the second stage (3-6 weeks), the aerobic exercise intensity was targeted to reach 12-15
      points on the RPE scale. Patients performed upper-limb resistance exercise (raising of a
      250-cc water bottle) and lower-limb stepping for 20 min per day as well as walking exercise
      (slow walking for 5 min and fast walking for 2 min, followed by 5-min slow walking, for a
      total of 30 min). Incentive spirometry training (Triflo-II) was performed 8-10 times per
      hour, and a threshold load trainer was used to train the inspiratory muscle (30 breaths each
      time, twice per day), with the pressure intensity adjusted to more than 5% of that in the
      first stage.Researchers contacted patients at home every week through phone calls to monitor
      the occurrence of any uncomfortable reaction and to encourage patients to continue their
      rehabilitation program.
    

Intervention name(s): Home-based Pulmonary Rehabilitation
Intervention type(s): Other
Intervention description(s): (1) breathing exercises (pursed-lip and diaphragmatic breathing) and coughing exercises, (2) aerobic exercises (upper and lower limb exercises and walking), (3) incentive spirometry training (Triflo-II), and (4) threshold load training of the inspiratory muscle. In the first stage (0-2 weeks), the aerobic exercise intensity was targeted to reach 10-11 points on the 20-point Borg rating of perceived exercise (RPE) scale. Patients raised their upper limbs while simultaneously performing lower-limb stepping at place for 20 min; in addition, they walked at a comfortable speed for 15 min twice per day. Incentive spirometry training (Triflo-II) was performed 8-10 times per hour. We used a threshold load trainer for inspiratory muscle training (30 breaths each time, twice per day) with the initial pressure set at 25%-30% of the maximum inspiratory pressure.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This study employed a prospective, randomized, and controlled clinical design to determine the efficacy of home-based pulmonary rehabilitation in patients after thoracoscopy. After participants signed the consent form, they were randomly included into the control or experimental group on the day of discharge. The random assignment was performed based on simple randomization by using numbers from 1 to 36; numbered, sealed, opaque envelopes were used for allocation concealment. These envelopes were randomly distributed by non researchers and recorded.
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Pulmonary rehabilitation; surgery; exercise