Infectious diseases

Timing is everything: study shows pre-op physiotherapy beats post-op


A single, 30 minute physiotherapy session delivered before major abdominal surgery can halve the risk of postoperative pulmonary complications including pneumonia.

A randomised controlled trial comprising 441 adults across three hospitals in Australia and New Zealand tested the addition of a physiotherapy education and breathing exercise training session to the standard pre-admission physiotherapy assessment plus an information booklet about complications and their prevention.

All participants received standard postoperative physiotherapy and a reminder about their breathing exercises.

The intervention group was shown to have a statistically significant reduction in pulmonary complications within 14 days of surgery or at discharge compared to controls (12% v 27%).

The incidence of hospital-acquired pneumonia was also halved in the intervention group compared to controls (8% v 20%).

Ms Ianthe Boden, cardiorespiratory clinical lead in physiotherapy at the Launceston General Hospital, told the limbic the findings supported earlier research.

“We’re over the moon that we have validated what we thought were relatively fanciful results from the previous studies – five preceding randomised controlled trials which had indicated that this was possible.”

She said the evidence suggested that physiotherapy resources should be re-allocated.

“Pre-op is the best option. If we see people postoperatively, it’s too late, the horse has bolted and they have pneumonia by the time we see them.”

“We can’t as a society overlook a low cost, no harm simple intervention which patients would receive as part and parcel of a clinic which they have to attend anyway.”

Some evidence for a mortality benefit

The trial also found evidence that the intervention had a mortality benefit at 12 months in patients managed by an experienced physiotherapist (7% v 12%).

“If I was having surgery, I think I’d be happy to take that percentage drop with a single 30 minute session,” she said.

Ms Boden added that it would be unethical to test the mortality benefit in a larger study.

“Our trial is the last of six and every single trial has shown a consistent effect that physiotherapy before surgery prevents pneumonia.”

“We also have trial after trial that confirm that pneumonia after surgery increases mortality. How could we do this ethically? How could we put someone into a control group and say we aren’t going to give you physiotherapy before surgery just so we can see if you are going to die in a year’s time?”

The intervention also stacks up from a cost-effectiveness point of view with the potential to prevent costly chest infections.

“For a 30 minute session that costs $50, how could we not provide that to our patients? Based on what we know now, this is the most cost effective way to reduce mortality and pneumonia with no harm. Not a single patient is at any risk from doing this.”

Interviews with a subgroup of patients in the intervention group revealed they found the pre-operative physiotherapy session empowering, that they felt in control, had something to do and the ability to change their outcome rather than being reliant on other people.

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