The Effects of Qigong Exercise Training After Thoracotomy
Condition: Pain, Shoulder; Postoperative Pain; Joint Adhesion; Muscle Weakness; Respiratory Function Loss; Quality of Life
MeSH terms: Muscle Weakness; Shoulder Pain
Study type: Interventional

Summary: 
      Postoperative pulmonary complications after thoracotomy cause morbidity and mortality.
      Although the causes of postoperative pulmonary complication are multifactorial, respiratory
      muscle dysfunction is a contributing factor to the development of postoperative pulmonary
      complication. This phenomenon has been explained by changes in respiratory muscle mechanics
      and operative function. Exercise interventions following lung resection have been shown to be
      associated with benefits on functional capacity, quality of life, shoulder pain, and shoulder
      function. Following thoracotomy, postoperative pulmonary complications are a significant
      cause of morbidity and cause significant increase in health care costs, intensive care and
      hospital stay, and patient discomfort. Conventional physiotherapy and rehabilitation program
      applied after thoracotomy reduces hospital stay and incidence of atelectasis.

      Thoracotomy may also result in long-term limitation of shoulder function and range of motion,
      reduced muscle strength, chronic pain, and reduced health-related quality of life.
      Physiotherapy program; It provides some benefits such as reduction of pain, improvement of
      shoulder function and physical components of quality of life. Based on these findings; It is
      recommended that physiotherapists provide a postoperative exercise program aimed at reducing
      shoulder dysfunction and pain, including progressive shoulder and rib cage exercises and a
      home program after discharge.

      In recent years, the popularity of Tai Chi, Qigong and yoga, also known as body-mind
      exercises in the treatment of chronic diseases, has increased.
    

Detailed description: 
      A standard posterolateral thoracotomy incision is usually performed in lung surgery due to
      its various advantages. Standard posterolateral thoracotomy is also used in lung problems
      such as lung parenchyma problems, hydatid cyst, mesothelioma, bullous disease of the lung
      along with cancer. In a standard posterolateral thoracotomy, the latissimus dorsi and
      serratus anterior muscles are cut. Latissimus dorsi muscle; Although it is very effective in
      deep inspiration, strong cough, shoulder girdle activity, it is also the accessory muscle of
      expiration. When the past 90 years are examined, standard posterolateral thoracotomy; It has
      been found that there are some disadvantages such as postoperative pulmonary complications
      due to cutting large muscle groups, increased potential blood loss, restricted shoulder and
      upper extremity joint range of motion, prolonged dysfunction, scoliosis formation, severe and
      chronic postoperative pain and cosmetic problems. These; Cutting large muscle groups,
      damaging the shoulder girdle muscles, restricting shoulder and upper extremity joint
      movements, causing postoperative pulmonary failure, pain and morbidity. The standard
      posterolateral thoracotomy is the most commonly used incision in non-cardiac open thoracic
      surgical procedures. The fact that it can be applied in all thoracic pathologies makes it the
      most used incision. Allowing the operating surgeon and assistant to use their hands together
      in the thoracic cavity and providing a good view for the thoracic cavity; posterolateral
      thoracotomy is the advantages of the incision.

      Postoperative pulmonary complications after thoracotomy cause morbidity and mortality.
      Although the causes of postoperative pulmonary complication are multifactorial, respiratory
      muscle dysfunction is a contributing factor to the development of postoperative pulmonary
      complication. This phenomenon has been explained by changes in respiratory muscle mechanics
      and operative function. Exercise interventions following lung resection have been shown to be
      associated with benefits on functional capacity, quality of life, shoulder pain, and shoulder
      function. Physiotherapy interventions have been used regularly since the 1960s for the
      prevention and treatment of both pulmonary and musculoskeletal complications following major
      surgery. Following thoracotomy, postoperative pulmonary complications are a significant cause
      of morbidity and cause significant increase in health care costs, intensive care and hospital
      stay, and patient discomfort. Conventional physiotherapy and rehabilitation program applied
      after thoracotomy reduces hospital stay and incidence of atelectasis. Early postoperative
      pulmonary rehabilitation after lung surgery can improve lung function by increasing
      cardiopulmonary and peripheral muscle endurance of patients.

      Thoracotomy can also cause long-term limitation of shoulder function and range of motion,
      reduced muscle strength, chronic pain, and reduced health-related quality of life.
      Physiotherapy program; It provides some benefits such as reduction of pain, improvement of
      shoulder function and physical components of quality of life. Based on these findings; It is
      recommended that physiotherapists provide a postoperative exercise program aimed at reducing
      shoulder dysfunction and pain, including progressive shoulder and rib cage exercises and a
      home program after discharge.

      In a study, it was found that a postoperative exercise program accompanied by a
      physiotherapist provides significant benefits in pain and shoulder functions for patients
      after open thoracotomy. During the hospital stay, physiotherapists focus on the prevention
      and management of postoperative pulmonary complications and the improvement of patients'
      thoracic and shoulder mobility. Among the treatment methods for postoperative pulmonary
      complications; breathing exercises consisting of active breathing technique, deep breathing
      exercises, incentive spirometry, continuous maximum inspiration, intermittent positive
      pressure breathing and positive expiratory pressure devices, cough maneuvers and forced
      expiratory technique. In addition, early-stage functional activities such as getting out of
      bed, taking steps in place, walking, climbing stairs and cycling have been included as
      treatment options for postoperative pulmonary complications and to improve physical function.
      Maintaining shoulder and trunk mobility can be achieved with shoulder and trunk range of
      motion exercises.

      In recent years, the popularity of Tai Chi, Qigong and yoga, also known as body-mind
      exercises in the treatment of chronic diseases, has increased.

      They are recommended as a category of exercise that includes a range of movements and body
      positions, focused on breathing, defined by a calm state of mind and deep relaxation. These
      exercises are; It includes many common components such as mind-focused, slow, relaxed,
      fluent, respiratory-oriented, and providing deep physical and mental relaxation.

      Tai Chi and Qigong exercises are rooted in ancient China, as are traditional Chinese medicine
      practices. Originally a spiritual practice, Yoga originated in India. These practices have
      been shown to have many health benefits. Many randomized controlled trials such as
      fibromyalgia, breast cancer, cardiovascular conditions, and diabetes have focused on the
      positive effects of moving meditation on specific medical conditions of various populations.

      In addition to conventional physiotherapy and rehabilitation after thoracotomy, Qigong
      exercise training applied for 8 weeks; In this study, which was planned to evaluate the
      effects on shoulder function, shoulder joint range of motion, shoulder muscle strength,
      post-thoracotomy incision pain and shoulder pain, dyspnea respiratory function, respiratory
      muscle strength, functional capacity and quality of life, he was hospitalized in Akdeniz
      University Hospital Thoracic Surgery clinic and underwent standard posterolateral
      thoracotomy. Patients who meet the criteria between 20-70 years of age will be taken. The
      control group will consist of patients who received conventional physiotherapy and
      rehabilitation in the post-thoracotomy period. The study group, on the other hand, will
      consist of patients who underwent qigong exercises in addition to the conventional
      physiotherapy and rehabilitation program in the post-thoracotomy period.

      Pain, shoulder mobility, shoulder muscle strength, shoulder function, dyspnea, respiratory
      function, respiratory muscle strength, respiratory muscle endurance, functional capacity,
      quality of life will be evaluated for outcome measures.

      Evaluations will be repeated in the preoperative period, postoperative 7th day, postoperative
      4th week, and postoperative 8th week.

      Conventional physiotherapy and rehabilitation will be applied to all patients participating
      in the study.

      The program includes progressive ambulation and progressive shoulder and rib cage exercises.
      These exercises will be performed under the supervision of a physiotherapist from the first
      postoperative day.

      The exercises will be advanced every day by increasing the number of repetitions. In addition
      to the study group, 8 weeks of Qigong exercise training will be applied.

      As a result of the literature study, no study was found that evaluated the effectiveness of
      qigong exercise training applied after thoracotomy on shoulder and respiratory functions.
      Therefore, in our study; qigong exercise training to be applied in addition to conventional
      physiotherapy after thoracotomy; It is thought that it will reduce shoulder and upper
      extremity joint range of motion, limitation in shoulder functions, decrease in shoulder
      muscle strength, postoperative pulmonary complications, and increase quality of life and
      functions.

      The hypotheses of the study are as follows. H0: Shoulder and respiratory functions of the
      patients who underwent qigong exercise training after thoracotomy were not better than the
      control group.

      H1: Shoulder and respiratory functions of the patients who underwent qigong exercise training
      after thoracotomy were better than the control group.

      This study will be performed on patients who will undergo posterolateral thoracotomy surgery
      in the Department of Thoracic Surgery of Akdeniz University Medical Faculty Hospital. The
      control group will consist of patients who underwent conventional physiotherapy and
      rehabilitation in the post-thoracotomy period. The study group will consist of patients who
      underwent qigong exercises in addition to the conventional physiotherapy and rehabilitation
      program in the post-thoracotomy period.
    

Intervention name(s): Qigong exercise training
Intervention type(s): Other
Intervention description(s): Before and after the qigong exercises, 10-minute exercises will be done to stretch the large muscle groups for warm-up-cooling purposes.
The entire Baduanjin exercise consists of 8 postures:
preparation position
Raising arms with palms up,
Shooting arrows left and right like an archer in a semi-crouching position
Keeping one arm up
Looking back with trunk rotations in a semi-crouching position
Nodding the head and lowering the body to relieve stress,
Fisting and staring
Touching feet with hands touching back and legs
Raising and lowering heels
Other intervention name(s): Therapeutic Baduanjin Qigong Exercises
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Thoracotomy; Qigong exercise training; Shoulder function; Respiratory function; Quality of life; Pain