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Potentially modifiable factors contribute to limitation in physical activity following thoracotomy and lung resection: a prospective observational study.

Agostini, Paula J and Naidu, Babu and Rajesh, Pala and Steyn, Richard and Bishay, Ehab and Kalkat, Maninder and Singh, Sally (2014) Potentially modifiable factors contribute to limitation in physical activity following thoracotomy and lung resection: a prospective observational study. Journal of cardiothoracic surgery, 9. p. 128. ISSN 1749-8090.

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Official URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC428312...

Abstract

BACKGROUND

Early mobility is considered important in minimising pulmonary complication, length of stay (LOS) and enhancing recovery following major surgery. We aimed to observe and measure the reduction in early postoperative physical activity following major thoracic surgery, identifying any potentially limiting factors, and factors predictive of reduced activity.

METHODS

Patients undergoing thoracotomy and lung resection were prospectively observed for the purposes of this study. All patients were routinely assisted to mobilise by physiotherapists from postoperative day 1, and continued daily with exercise and progression of mobility as per usual practice. Physical activity was measured with SenseWear Pro 3 armband physiologic motion sensors between postoperative day 1-4. The motion sensors recorded step count, time spent in 'sedentary'/ 'moderate' activity, and energy expenditure. Frequency of postoperative pulmonary complication (PPC) and postoperative LOS were also observed. Multivariate analyses were performed using forward stepwise logistic regression; results are displayed as odds ratio (95% confidence intervals).

RESULTS

n = 99, median (interquartile range) steps 472 (908) over combined postoperative days 2/ 3, sedentary activity (< 3 METs) 99%. Less active subjects reported significantly more pain on day 2 and 3 (p = 0.013/ 0.00 respectively) (p < 0.001). On regression analysis age ≥ 75 years, predicted FEV1 <  70% and poor preoperative activity were predictive of lower postoperative activity. Factors limiting mobility on day 1 included pain and dizziness. Median LOS was longer (p = 0.013) (6 vs. 5 days) in less active patients and frequency of PPC was 20% vs 4% (p = 0.034).

CONCLUSION

Physical activity following major thoracic surgery is generally very limited, with less active patients demonstrating longer LOS. Factors limiting immediate postoperative mobility were largely modifiable, some of the factors predictive of lower activity were also possibly modifiable/amenable to physiotherapy or pulmonary rehabilitation. Prompt assessment and recognition of these factors is needed in future, with timely and effective management incorporated into care pathways to maximise each patients potential to mobilise postoperatively.

TRIAL REGISTRATION

ISRCTN52709424.

Item Type: Article
Subjects: WF Respiratory system. Respiratory medicine
WG Cardiovascular system. Cardiology
Divisions: Planned IP Care > Thoracic Surgery
Related URLs:
Depositing User: Mrs Yolande Brookes
Date Deposited: 16 Apr 2015 10:20
Last Modified: 16 Apr 2015 10:20
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/844

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