title: Potentially modifiable factors contribute to limitation in physical activity following thoracotomy and lung resection: a prospective observational study.
abstract: BACKGROUND
  Early mobility is considered important in minimising pulmonary complication, length of stay (LOS) and enhancing recovery following major surgery. We aimed to observe and measure the reduction in early postoperative physical activity following major thoracic surgery, identifying any potentially limiting factors, and factors predictive of reduced activity.
  
  
  METHODS
  Patients undergoing thoracotomy and lung resection were prospectively observed for the purposes of this study. All patients were routinely assisted to mobilise by physiotherapists from postoperative day 1, and continued daily with exercise and progression of mobility as per usual practice. Physical activity was measured with SenseWear Pro 3 armband physiologic motion sensors between postoperative day 1-4. The motion sensors recorded step count, time spent in 'sedentary'/ 'moderate' activity, and energy expenditure. Frequency of postoperative pulmonary complication (PPC) and postoperative LOS were also observed. Multivariate analyses were performed using forward stepwise logistic regression; results are displayed as odds ratio (95% confidence intervals).
  
  
  RESULTS
  n = 99, median (interquartile range) steps 472 (908) over combined postoperative days 2/ 3, sedentary activity (< 3 METs) 99%. Less active subjects reported significantly more pain on day 2 and 3 (p = 0.013/ 0.00 respectively) (p < 0.001). On regression analysis age ≥ 75 years, predicted FEV1 <  70% and poor preoperative activity were predictive of lower postoperative activity. Factors limiting mobility on day 1 included pain and dizziness. Median LOS was longer (p = 0.013) (6 vs. 5 days) in less active patients and frequency of PPC was 20% vs 4% (p = 0.034).
  
  
  CONCLUSIONS
  Physical activity following major thoracic surgery is generally very limited, with less active patients demonstrating longer LOS. Factors limiting immediate postoperative mobility were largely modifiable, some of the factors predictive of lower activity were also possibly modifiable/amenable to physiotherapy or pulmonary rehabilitation. Prompt assessment and recognition of these factors is needed in future, with timely and effective management incorporated into care pathways to maximise each patients potential to mobilise postoperatively.
  
  
  BACKGROUND
  ISRCTN52709424.
authors.affiliation: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Bordesley Green, Birmingham, UK. paula.agostini@heartofengland.nhs.uk.
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Agostini
authors.forename: Babu
authors.initials: B
authors.lastname: Naidu
authors.forename: Pala
authors.initials: P
authors.lastname: Rajesh
authors.forename: Richard
authors.initials: R
authors.lastname: Steyn
authors.forename: Ehab
authors.initials: E
authors.lastname: Bishay
authors.forename: Maninder
authors.initials: M
authors.lastname: Kalkat
authors.forename: Sally
authors.initials: S
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D016017:Odds Ratio; D026741:Physical Therapy Modalities; D011013:Pneumonectomy / Q000534:rehabilitation; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011184:Postoperative Period; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D013908:Thoracotomy / Q000534:rehabilitation; D055815:Young Adult