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Physiotherapy interventions and outcomes following lung cancer surgery
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0001-7085-6507
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to evaluate the effect of exercise training and inspiratory muscle training and to describe pulmonary function, respiratory muscle strength, physical performance and health-related quality of life (HRQoL) following lung cancer surgery.

Study I was a randomised controlled trial including 78 patients radically operated for lung cancer. The intervention group received 10 sessions of supervised exercise training in addition to home-based exercise; the control group was instructed on home-exercise alone. Supervised compared to non-supervised exercise training did not result in differences between groups in HRQoL, except for the SF-36 bodily pain domain four months after the surgery. No effects of supervised training were found for any outcome after one year.

Study II was descriptive and was based on the study I sample. We evaluated the course of recovery of HRQoL and physical performance up to one year following surgery. All patients improved HRQoL and physical performance one year after the surgery, reaching values comparable to a reference healthy population. The walked distance was positively associated with the SF-36 domain for physical functioning.

Study III was descriptive, included 81 patients and evaluated the influence of surgery on respiratory muscle strength, lung function and physical performance two weeks and six months after surgery. We found that respiratory muscle strength was not affected after the second postoperative week and that muscle-sparring thoracotomy did not deteriorate respiratory muscle strength, compared to video-assisted thoracic surgery. Compared to preoperative values, physical performance was recovered, whereas lung function remained reduced six months postoperatively.

Study IV was a randomised controlled trial including 68 patients at high risk of developing postoperative pulmonary complications (PPC). This study evaluated the effects of two weeks of postoperative inspiratory muscle training in addition to breathing exercises and early mobilisation on respiratory muscle strength and the incidence of PPC. Additional inspiratory muscle training did not increase respiratory muscle strength, but improved postoperative oxygenation. Respiratory muscle strength was recovered in both groups two weeks postoperatively.

Place, publisher, year, edition, pages
Örebro: Örebro university , 2015. , 66 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 129
Keyword [en]
lung cancer, surgery, quality of life, exercise, inspiratory muscle training, physical performance, pulmonary complications
National Category
Surgery Medical and Health Sciences
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-45728ISBN: 978-91-7529-097-3 (print)OAI: oai:DiVA.org:oru-45728DiVA: diva2:851753
Public defence
2015-11-23, Universitetssjukhuset, hörsal C1, Södra Grev Rosengatan, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2015-09-07 Created: 2015-09-07 Last updated: 2017-10-17Bibliographically approved
List of papers
1. Short and long-term effects of supervised versus unsupervised exercise training on health-related quality of life and functional outcomes following lung cancer surgery: a randomized controlled trial
Open this publication in new window or tab >>Short and long-term effects of supervised versus unsupervised exercise training on health-related quality of life and functional outcomes following lung cancer surgery: a randomized controlled trial
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2014 (English)In: Lung Cancer, ISSN 0169-5002, E-ISSN 1872-8332, Vol. 83, no 1, 102-108 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

Surgical resection enhances long-term survival after lung cancer, but survivors face functional deficits and report on poor quality of life long time after surgery. This study evaluated short and long-term effects of supervised group exercise training on health-related quality of life and physical performance in patients, who were radically operated for lung cancer.

METHODS:

A randomized, assessor-blinded, controlled trial was performed on 78 patients undergoing lung cancer surgery. The intervention group (IG, n=41) participated in supervised out-patient exercise training sessions, one hour once a week for ten weeks. The sessions were based on aerobic exercises with target intensity of 60-80% of work capacity, resistance training and dyspnoea management. The control group (CG, n=37) received one individual instruction in exercise training. Measurements consisted of: health-related quality of life (SF36), six minute walk test (6MWT) and lung function (spirometry), assessed three weeks after surgery and after four and twelve months.

RESULTS:

Both groups were comparable at baseline on demographic characteristic and outcome values. We found a statistically significant effect after four months in the bodily pain domain of SF36, with an estimated mean difference (EMD) of 15.3 (95% CI:4 to 26.6, p=0.01) and a trend in favour of the intervention for role physical functioning (EMD 12.04, 95% CI: -1 to 25.1, p=0.07) and physical component summary (EMD 3.76, 95% CI:-0.1 to 7.6, p=0.06). At 12 months, the tendency was reversed, with the CG presenting overall slightly better measures. We found no effect of the intervention on 6MWT or lung volumes at any time-point.

CONCLUSION:

Supervised compared to unsupervised exercise training resulted in no improvement in health-related quality of life, except for the bodily pain domain, four months after lung cancer surgery. No effects of the intervention were found for any outcome after one year.

Place, publisher, year, edition, pages
Elsevier, 2014
Keyword
physical therapy, thoracic surgery, coronary artery bypass, post-operative complications, positivepressure respiration, respiratory function tests
National Category
Cancer and Oncology
Research subject
Rehabilitation Medicine; Oncology
Identifiers
urn:nbn:se:oru:diva-34131 (URN)10.1016/j.lungcan.2013.10.015 (DOI)000330153200017 ()24246508 (PubMedID)2-s2.0-84891738419 (Scopus ID)
Note

Funding Agencies:

Danish Cancer Research Foundation

Danish Physiotherapist Association and Aalborg University Hospital

Available from: 2014-03-11 Created: 2014-03-11 Last updated: 2017-12-05Bibliographically approved
2. Improvements in physical performance and health-related quality of life one year after radical operation for lung cancer
Open this publication in new window or tab >>Improvements in physical performance and health-related quality of life one year after radical operation for lung cancer
2015 (English)In: Cancer Treatment Communications, ISSN 2213-0896, Vol. 4, 65-74 p.Article in journal (Refereed) Published
Abstract [en]

Micro abstract: This study assessed physical performance and health-related quality of life one year after lung cancer surgery and investigated the potential association between both outcomes. We found that the walked distance was associated with the subjective perception of the physical functioning. Patients improved health-related quality of life, reaching values similar to a healthy reference population.

Background: Resuming an acceptable level of lifestyle and health-related quality of life after lung cancer surgery has become an important issue. We aimed to evaluate the course of recovery of physical performance and health-related quality of life following pulmonary resection for lung cancer, as well as examine the potential association between these outcomes.

Methods: In an observational design, we assessed 78 individuals radically operated for lungcancer. We measured health-related quality of life (SF-36), six-minute walk test (6MWT) and lung function (spirometry)three weeks (baseline), four and twelve months after surgery. SF-36 values were compared to an age-and gender-matched reference population.

Results: The mean age was 65 years (SD9), 59% were males. Thoracotomy was performed in 77% of the cases. Compared to baseline values, we found significant improvements after one year in SF-36 physical and mental component summary components of large effect size (0.8 and 0.9 respectively). Values for both SF-36 summary components were comparable to those of the reference population. The improvement in 6MWT was of moderate effect size (0.6). We found a positive association between 6MWT and the SF-36 domain for physical functioning (β=0.05, 95% CI [0.00;0.09], p=0.03) one year after surgery.

Conclusion: Individuals who were radically operated for lung cancer improved health-related quality of life one year after surgery, reaching values similar to a healthy reference population. The walked distance was positively associated with the subjective perception of physical functioning. The clinical significance of these findings deserves further investigation.

Place, publisher, year, edition, pages
Elsevier, 2015
Keyword
Lung cancer; Surgery; Quality of life; SF-36; Six-minute walk test; Long-term
National Category
Surgery Physiotherapy
Identifiers
urn:nbn:se:oru:diva-46376 (URN)10.1016/j.ctrc.2015.05.004 (DOI)
Available from: 2015-11-02 Created: 2015-11-02 Last updated: 2017-10-18Bibliographically approved
3. Respiratory muscle strength is not affected two weeks and six months following pulmonary resection
Open this publication in new window or tab >>Respiratory muscle strength is not affected two weeks and six months following pulmonary resection
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(English)Manuscript (preprint) (Other academic)
National Category
Surgery Physiotherapy
Identifiers
urn:nbn:se:oru:diva-46389 (URN)
Available from: 2015-11-03 Created: 2015-11-03 Last updated: 2017-10-17Bibliographically approved
4. Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: a randomized controlled trial
Open this publication in new window or tab >>Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: a randomized controlled trial
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2016 (English)In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 49, no 5, 1483-1491 p., 26489835Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES The aim was to investigate whether 2 weeks of inspiratory muscle training (IMT) could preserve respiratory muscle strength in high-risk patients referred for pulmonary resection on the suspicion of or confirmed lung cancer. Secondarily, we investigated the effect of the intervention on the incidence of postoperative pulmonary complications.

METHODS The study was a single-centre, parallel-group, randomized trial with assessor blinding and intention-to-treat analysis. The intervention group (IG, n = 34) underwent 2 weeks of postoperative IMT twice daily with 2 × 30 breaths on a target intensity of 30% of maximal inspiratory pressure, in addition to standard postoperative physiotherapy. Standard physiotherapy in the control group (CG, n = 34) consisted of breathing exercises, coughing techniques and early mobilization. We measured respiratory muscle strength (maximal inspiratory/expiratory pressure, MIP/MEP), functional performance (6-min walk test), spirometry and peripheral oxygen saturation (SpO2), assessed the day before surgery and again 3–5 days and 2 weeks postoperatively. Postoperative pulmonary complications were evaluated 2 weeks after surgery.

RESULTS The mean age was 70 ± 8 years and 57.5% were males. Thoracotomy was performed in 48.5% (n = 33) of cases. No effect of the intervention was found regarding MIP, MEP, lung volumes or functional performance at any time point. The overall incidence of pneumonia was 13% (n = 9), with no significant difference between groups [IG 6% (n = 2), CG 21% (n = 7), P = 0.14]. An improved SpO2 was found in the IG on the third and fourth postoperative days (Day 3: IG 93.8 ± 3.4 vs CG 91.9 ± 4.1%, P = 0.058; Day 4: IG 93.5 ± 3.5 vs CG 91 ± 3.9%, P = 0.02). We found no association between surgical procedure (thoracotomy versus thoracoscopy) and respiratory muscle strength, which was recovered in both groups 2 weeks after surgery.

CONCLUSIONS Two weeks of additional postoperative IMT, compared with standard physiotherapy alone, did not preserve respiratory muscle strength but improved oxygenation in high-risk patients after lung cancer surgery. Respiratory muscle strength recovered in both groups 2 weeks after surgery.

Place, publisher, year, edition, pages
Oxford University Press, 2016
Keyword
Inspiratory muscle training; lung cancer; surgery; pulmonary complications, postoperative; physiotherapy
National Category
Medical and Health Sciences Surgery Physiotherapy
Research subject
Surgery esp. Thoracic and Cardivascular Surgery
Identifiers
urn:nbn:se:oru:diva-46375 (URN)10.1093/ejcts/ezv359 (DOI)
Available from: 2015-11-02 Created: 2015-11-02 Last updated: 2017-10-18Bibliographically approved

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