title: Does the addition of deep breathing exercises to physiotherapy-directed early mobilisation alter patient outcomes following high-risk open upper abdominal surgery? Cluster randomised controlled trial.
abstract: OBJECTIVE
  To investigate whether the inclusion of deep breathing exercises in physiotherapy-directed early mobilisation confers any additional benefit in reducing postoperative pulmonary complications (PPCs) when patients are treated once daily after elective open upper abdominal surgery. This study also compared postoperative outcomes following early and delayed mobilisation.
  
  
  METHODS
  Cluster randomised controlled trial.
  
  
  METHODS
  Single-centre study in a teaching hospital.
  
  
  METHODS
  Eighty-six high-risk patients undergoing elective open upper abdominal surgery.
  
  
  METHODS
  Three groups: early mobilisation (Group A), early mobilisation plus breathing exercises (Group B), and delayed mobilisation (mobilised from third postoperative day) plus breathing exercises (Group C).
  
  
  RESULTS
  PPCs and postoperative outcomes [number of days until discharge from physiotherapy, physiotherapy input and length of stay (LOS)].
  
  
  RESULTS
  There was no significant difference in PPCs between Groups A and B. The LOS for Group A {mean 10.7 [standard deviation (SD) 5.0] days} was significantly shorter than the LOS for Groups B [mean 16.7 (SD 9.7) days] and C [mean 15.2 (SD 9.8) days; P=0.036]. The greatest difference was between Groups A and B (mean difference -5.93, 95% confidence interval -10.22 to -1.65; P=0.008). Group C had fewer smokers (26%) and patients with chronic obstructive pulmonary disease (0%) compared with Group B (53% and 14%, respectively). This may have led to fewer PPCs in Group C, but the difference was not significant. Despite Group C having fewer PPCs and less physiotherapy input, the number of days until discharge from physiotherapy and LOS were similar to Group B.
  
  
  CONCLUSIONS
  The addition of deep breathing exercises to physiotherapy-directed early mobilisation did not further reduce PPCs compared with mobility alone. PPCs can be reduced with once-daily physiotherapy if the patients are mobilised to a moderate level of exertion. Delayed mobilisation tended to increase physiotherapy input and the number of days until discharge from physiotherapy compared with early mobilisation.
authors.affiliation: Department of Physiotherapy, Concord Repatriation General Hospital, Concord, Australia. yasmin.silva@sswahs.nsw.gov.au
authors.forename: Y R
authors.initials: YR
authors.lastname: Silva
authors.forename: S K
authors.initials: SK
authors.lastname: Li
authors.forename: M J F X
authors.initials: MJ
authors.lastname: Rickard
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001945:Breathing Exercises / Q000379:methods*; D004434:Early Ambulation / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D017211:Treatment Failure