The physiotherapy management of patients undergoing thoracic surgery. A survey of current practice in Australia and New Zealand [Abstract]
Reeve, JC; Denehy, L; Stiller, K
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Physiotherapy is considered an essential component of the management of patients following thoracotomy, yet the type of interventions utilised and evidence of their efficacy has not been clearly established. This study aimed to ascertain the current physiotherapy management of patients undergoing thoracotomy. A purpose-designed postal questionnaire was distributed to senior physiotherapists in all thoracic surgical units throughout Australia and New Zealand (n = 57). A response rate of 81% was obtained (n = 46). Preoperatively, 35% (n = 16) of respondents assessed all patients presenting for thoracotomy, 41% (n = 19) assessed only some patients (usually based on risk assessment) with 24% (n = 11) undertaking no preoperative physiotherapy assessment or treatment. The majority of respondents (96%, n = 44) attended all patients following surgery, with 63% (n = 29) performing prophylactic physiotherapy interventions to prevent postoperative pulmonary complications. Others assessed all patients postoperatively but treated only when appropriate (33%, n = 15). Physiotherapy usually commenced on day one postoperatively (80%, n = 37) with the most commonly used treatment interventions being deep breathing exercises, active cycle of breathing techniques, cough, forced expiratory techniques and sustained maximal inspirations. Most respondents reported patients sat out of bed on day one postoperatively (89%, n = 41) and commenced walking on day one (70%, n = 32). Shoulder range of movement exercises also normally commenced on day one (50%, n = 23). The majority of respondents offered no postoperative pulmonary rehabilitation (54%, n = 25), outpatient follow up (94%, n = 43) or post-thoracotomy pain management (87%, n = 40). While most patients after thoracotomy receive physiotherapy assessment and/or treatment postoperatively, relatively few are reviewed following discharge from hospital.