Preserving pulmonary function and functional capacity in children undergoing open abdominal surgery: A one group pretest-posttest, quasiexperimental pilot trial

Effects of exercise-based prehabilitation in children undergoing elective surgeries: a systematic review

Background: Prehabilitation is a therapeutic strategy involving preoperative physical exercises, nutritional support, and stress and anxiety reduction. This approach has been gaining popularity and has been seeing effective results in adults in terms of improving pre and postoperative outcomes. The purpose of this review was to summarise the evidence about the effects of exercise-based prehabilitation programs on various outcome measures in children post elective surgeries.­­

Methods: PubMed, Scopus, Web of Science, PEDro, CINAHL/EBSCO and EMBASE electronic databases were searched from inception to June 2021. Based on the inclusion criteria, titles and abstracts were independently screened by the authors. After that, a data extraction table of the selected studies which included the participants, type, and details of exercise intervention, outcome measures and results were analysed after which the quality assessment of the studies was done.

Results: The search yielded 2219 articles of which three articles fulfilled the inclusion criteria with two studies being randomized controlled trials and one being a quasi-experimental pre-post type of study. One randomized controlled trial was on the effects of exercise-based prehabilitation in reducing pulmonary complications post cardiac surgeries in children and the other two studies were on the effects of prehabilitation on functional capacity & pulmonary function. All the three articles found that exercise-based prehabilitation had a positive effect on children’s post-surgery.

Conclusion: Although there is a paucity of evidence-based literature, we conclude based on the existing literature retrieved by our review that exercise-based prehabilitation improves postoperative outcomes and helps in reducing postoperative complications in children undergoing various surgeries.

Repeated measures correlation between functional capacity, pulmonary function and chest expansion in children undergoing open abdominal surgery: Secondary analysis from randomized clinical trial

PURPOSE

Six minute walk test (6MWT), Spirometry and chest expansion are used regularly to investigate the status of functional capacity and pulmonary function pre and post operatively. We assessed whether Functional capacity Ten meter walk test (10mWT), Nine stair climbing test (9SCT), pulmonary function [Spirometry parameters (FVC, FEV1, FEV1/FVC ratio and PEFR)] and chest expansion have correlation in children undergoing open abdominal surgery.

METHODS

Total 18 children aged 5-17 years old undergoing open abdominal surgery participated in the study. The study follows secondary analysis from randomized clinical trial. 6MWT, Spirometry parameters (FVC, FEV1, FEV1/FVC ratio and PEFR), 10mWT, 9SCT, and Chest expansion measures were taken before [Preoperative day (Pre-OP)] and after open abdominal surgery [postoperative day one (POD1) and postoperative day five (POD5)].

RESULTS

Bivariate analysis showed no correlation (r_s <0.25; p>0.05) between Functional capacity and pulmonary function preoperatively, on POD1, and on POD5. 9SCT (Functional capacity) showed moderate to good correlation (r_s= 0.742; p<0.05) with pulmonary function at the Pre-OP. Chest expansion parameters also showed moderate to good correlation (r_s = 0.50-0.75; p<0.05) with the pulmonary function on Pre-OP, POD1, and POD5.

CONCLUSION

There is moderate correlation exists between pulmonary function and chest expansion, but poor correlation of functional capacity with pulmonary function and chest expansion. Hence, all the outcome measures (6MWT, 10Mwt, 9SCT, Spirometry, and Chest expansion) are having individual importance.

A randomized clinical trial in improving pulmonary function and functional capacity in pediatric open abdominal surgery

PURPOSE

Pulmonary function and functional capacity gets compromised and reduced after open abdominal surgery. We assessed whether Preoperative physiotherapy education (POPE) along with postoperative physiotherapy (POP) preserve pulmonary function and functional capacity after open abdominal surgery among Pediatric population. Hence, the goal of this study was to determine the effectiveness of POPE combined with POP against the standard treatment care of, Postoperative physiotherapy (POP) only in improving pulmonary function and functional capacity in pediatric open abdominal surgery.

METHODS

Twenty one children aged, 5-17 years old undergoing the open abdominal surgery were randomized to POPE and POP group (Intervention arm 1) and Postoperative physiotherapy group (POP) only group (Intervention arm 2). Primary outcome measure was pulmonary function measured by computerized spirometry. Six minute walk test (6MWT), Ten meter walk test (10mWT), Timed up and go test (TUGT) and Nine stair climbing test (9SCT) were used as secondary outcome measures to measure functional capacity along with chest expansion. Pulmonary function measured by spirometery, 10mWT, TUG and chest expansion were measured 1 day before undergoing abdominal surgery (Pre-OP), post-operative day 1 (POD1) and post-operative day 5 (POD5) while 6MWT and 9SCT were measured only at POD1 and POD5.

RESULTS

Eighteen children who were undergoing open abdominal surgery completed this trial. No statistical difference were noted in Spirometric parameters from Pre-OP to POD5 in both the groups, they are almost approximate to preoperative values, but from POD1 to POD5, statistical difference were noted in all the Spirometric parameters in Intervention arm 1 as compared to Intervention arm 2. Statistical significant improvement (p < 0.05) were noted in TUGT, 10mWT, 9SCT from Pre-OP to POD5 and from POD1 to POD5 also in Intervention arm 1 as compared to Intervention arm 2.

CONCLUSION

There is sufficient evidence to confirm that POPE combined with POP might improve pulmonary function and functional capacity in children undergoing open abdominal surgery.

TYPE OF STUDY

Treatment study.

LEVEL OF EVIDENCE

Level I.