title: Feasibility and effectiveness of pre-operative inspiratory muscle training in patients undergoing oesophagectomy: a pilot study.
abstract: BACKGROUND
  Patients undergoing oesophageal surgery have a high risk for post-operative complications including pulmonary infections. Recently, physical therapy has shifted from the post-operative to the pre-operative phase to diminish post-operative complications and to shorten hospital stay. The purpose of this pilot study was to investigate the feasibility and initial effectiveness of pre-operative inspiratory muscle training (IMT) on the incidence of pneumonia in patients undergoing oesophagectomy.
  
  
  METHODS
  A pragmatic non-randomized controlled trial was conducted among all patients who underwent an oesophagectomy between January 2009 and February 2010. Patients in the intervention group received IMT prior to surgery. Feasibility was assessed on the basis of the occurrence of adverse effects during testing or training and patient satisfaction. Initial effectiveness on respiratory function was evaluated by maximal inspiratory pressure (MIP) and endurance, the incidence of post-operative pneumonia and length of hospital stay.
  
  
  RESULTS
  Eighty-three patients were included, of which 44 received pre-operative IMT. No adverse effects were observed. IMT was well tolerated and appreciated. In the intervention group, the median MIP and endurance improved significantly after IMT by 32% and 41%, respectively (p < 0.001). The incidence of post-operative pneumonia and the length of hospital stay were comparable for the intervention and the conventional care groups (pneumonia, 25% vs. 23% [p = 0.84]; hospitalization, 13.5 vs. 12 days [p = 0.08]).
  
  
  CONCLUSIONS
  Pre-operative IMT is feasible in patients with oesophageal carcinoma and significantly improves respiratory muscle function. This, however, did not result in a reduction of post-operative pneumonia in patients undergoing oesophagectomy.
authors.affiliation: Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. d.s.dettling@amc.uva.nl
authors.forename: Daniela S
authors.initials: DS
authors.lastname: Dettling
authors.forename: Marike
authors.initials: M
authors.lastname: van der Schaaf
authors.forename: Rachel L G M
authors.initials: RL
authors.lastname: Blom
authors.forename: Frans
authors.initials: F
authors.lastname: Nollet
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.forename: Mark I
authors.initials: MI
authors.lastname: van Berge Henegouwen
mesh_terms: D000368:Aged; D001945:Breathing Exercises; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D001239:Inhalation / Q000502:physiology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D011014:Pneumonia / Q000453:epidemiology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D012132:Respiratory Muscles / Q000502:physiology*; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome