Pre-operative and Post-operative Physiotherapy in Children With Abdominal Surgery

Study Overview
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Brief Summary
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The study will be conducted in a pediatric surgery ward, department of pediatrics. Children between the ages of 5 to 17 years who underwent for abdominal surgery will be recruited by simple random sampling. Parents of all the potential participants will receive a written explanation of the trial and given written informed consent forms to be signed prior to their child being involved in the trial. Pre- op physiotherapy education is given to one experimental group and after surgery post operative treatment is given to both the experimental groups. spirometery, 6 minute walk test, 10 meter walk test, Timed up and go test and Nine star stair climbing test will be used for data collection.

Detailed Description
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Pre- operative education is given to the experimental group 1 only. Pre- op. physiotherapy education includes- Pursed lip breathing exercises × 10 repetitions Diaphragmatic breathing exercises × 10 repetitions Leg ROM (active hip and knee flexion, extension and abduction exercises) and ankle toe movements exercises × 10 repititions Post- op. physiotherapy will be given to both the experimental groups. it includes- On Post operative day 1 Deep breathing exercises- Pursed lip breathing exercises × Diaphragmatic breathing exercises (5 repetitions × 2 sets) Segmental breathing exercises × 5 repetitions × 2 sets Incentive spirometer 10 breaths up to 600 cc (In three sets) per session Leg Range of motion exercises (active hip and knee flexion and extension exercises) × 5 repetitions × 2 sets Ankle and toe movements× 10 repetitions × 2 sets Ambulation program High sitting minimum of 2 min Static March for 1 min Walk for 5 min. every 2 hourly Post operative day 2 Deep breathing exercises- Pursed lip breathing exercises × Diaphragmatic breathing exercises (5 repetitions × 2 sets) Segmental breathing exercises × 5 repetitions × 2 sets Incentive spirometer 10 breaths upto 600 cc (In three sets) per sessionThoracic expansion exercises- ACBT (Active cycles of breathing techniques) Diaphragmatic breathing (10 rep.), deep breathing (5 sec. hold), huffing x 2 repetitions twice a day Walk for 10 min. every 2 hourly Post operative day 3 Pursed lip breathing exercises x 10 repetitions x 2 sets Incentive spirometer 10 breaths upto 900cc (In three sets) per session Thoracic expansion exercises- ACBT Diaphragmatic breathing (5-10 rep.), deep breathing (5 sec. hold), huffing x 2 repetitions twice a day Walk for 15 min. every 2 hourly Post operative day 4 Incentive spirometer/ 10breaths upto 900cc (In three sets) per session Walk for 20 min. every 4 hourly Post operative day 5 Incentive spirometer / 10breaths upto 1000cc (In three sets) per session Stair climbing up to 9 steps in ascending and descending pattern for 5 minutes rest in between

Official Title
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Effects of Pre- Operative Physiotherapy Education and Post Operative Physiotherapy in Children With Abdominal Surgery

Conditions
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Abdominal Surgery

Intervention / Treatment
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* Procedure: Pre-operative physiotherapy education
* Procedure: Post-operative physiotherapy intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children having following abdominal incision- inguinal incision, left subcostal incision, right subcostal incision, kehr incision, McBurney incision, Transverse incison, thoraco-abdominal incison, Median and paramedian incision12 Between ages of 5 to 17 years Who follows and obeys the commands Children who is willing to participate in the study Exclusion Criteria: Children who requires organ transplants With mental retardation With physical disability

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Parallel
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Pre-operative physiotherapy education<br>Pre-operative education regarding post-operative physiotherapy intervention and post-operative physiotherapy intervention in children with abdominal surgery | Procedure: Pre-operative physiotherapy education<br>* Pre-operative education regarding post-operative physiotherapy intervention in children with abdominal surgery which includes, Deep breathing exercises Pursed lip breathing exercises Diaphragmatic breathing exercises Leg ROM (active hip and knee flexion, extension and abduction exercises) Ankle toe movements exercises<br>Procedure: Post-operative physiotherapy intervention<br>* Post-operative physiotherapy intervention which includes, Deep breathing exercises Pursed lip breathing exercises Diaphragmatic breathing exercises Leg ROM (active hip and knee flexion, extension and abduction exercises) Ankle toe movements exercises<br>|
| Experimental: Post-OP PT without Pre-OP education<br>Post-operative physiotherapy intervention without pre-operative education in children with abdominal surgery | Procedure: Post-operative physiotherapy intervention<br>* Post-operative physiotherapy intervention which includes, Deep breathing exercises Pursed lip breathing exercises Diaphragmatic breathing exercises Leg ROM (active hip and knee flexion, extension and abduction exercises) Ankle toe movements exercises<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in FVC (Liters) (spirometric measurements) | Functional vital capacity (FVC) is the maximum volume of air which can be exhaled or inspired during a forced maneuver | 3 times (recorded pre operative and post operative on day1 and 5) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 6 minute walk test | the child will be asked to walk far as possible for 6 minutes. Child will be encouraged in every minute for walking. At 6 minute, child will be asked to stop. If the participant stops at any time prior record the distance at which the oxygen saturation drops < 88% | 2 times (recorded pre operative and post operative on day 5) | 
| 10 meter walk test | The 10MWT assesses walking speed in meters per second over a short duration.The child will be asked to walk a set distance (10 meters). Time will be measured during walking. The distance covered is divided by the time it took the individual to walk that distance. | 3 times (recorded pre operative and post operative on day1 and 5) | 
| Nine stair climbing test | It is performed for measuring functional strength and balance through ascending and descending a set number of steps. 2min. time will be given to complete the test. The patient should use the assistive device (if any) normally used to perform the activity at the time of testing. | 2 times (recorded pre operative and post operative on day 5) | 
| Timed up and go test | The child starts in a seated position. The child will be tands up upon therapist's command walks 3 meters, turns around, walks back to the chair and sits down. The time stops when the child is seated. | 3 times (recorded pre operative and post operative on day1 and 5) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Abdomen, Children, Chest physical therapy, Surgery