title: Comparison of Flow and Volume Incentive Spirometry on Pulmonary Function and Exercise Tolerance in Open Abdominal Surgery: A Randomized Clinical Trial.
abstract: BACKGROUND
  Surgical procedures in abdominal area lead to changes in pulmonary function, respiratory mechanics and impaired physical capacity leading to postoperative pulmonary complications, which can affect up to 80% of upper abdominal surgery.
  
  
  OBJECTIVE
  To evaluate the effects of flow and volume incentive spirometry on pulmonary function and exercise tolerance in patients undergoing open abdominal surgery.
  
  
  METHODS
  A randomized clinical trial was conducted in a hospital of Mangalore city in Southern India. Thirty-seven males and thirteen females who were undergoing abdominal surgeries were included and allocated into flow and volume incentive spirometry groups by block randomization. All subjects underwent evaluations of pulmonary function with measurement of Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), Peak Expiratory Flow (PEF). Preoperative and postoperative measurements were taken up to day 5 for both groups. Exercise tolerance measured by Six- Minute Walk Test during preoperative period and measured again at the time of discharge for both groups. Pulmonary function was analysed by post-hoc analysis and carried out using Bonferroni's 't'-test. Exercise tolerance was analysed by Paired 'T'-test.
  
  
  RESULTS
  Pulmonary function (FVC, FEV1, and PEFR) was found to be significantly decreased in 1(st), 2(nd) and 3(rd) postoperative day when compared with preoperative day. On 4(th) and 5(th) postoperative day the pulmonary function (FVC, FEV1, and PEFR) was found to be better preserved in both flow and volume incentive spirometry groups. The Six-Minute Walk Test showed a statistically significant improvement in pulmonary function on the day of discharge than in the preoperative period. In terms of distance covered, the volume- incentive spirometry group showed a greater statistically significant improvement from the preoperative period to the time of discharge than was exhibited by the flow incentive spirometry group.
  
  
  CONCLUSIONS
  Flow and volume incentive spirometry can be safely recommended to patients undergoing open abdominal surgery as there have been no adverse events recorded. Also, these led to a demonstrable improvement in pulmonary function and exercise tolerance.
authors.affiliation: Lecturer, Department of Physiotherapy, Father Muller Medical College Hospital , RGUHS, India .
authors.forename: Amaravadi Sampath
authors.initials: AS
authors.lastname: Kumar
authors.affiliation: Associate Professor, Department of Physiotherapy, Kasturba Medical College, Manipal University , India .
authors.forename: Gopala Krishna
authors.initials: GK
authors.lastname: Alaparthi
authors.affiliation: Professor, Department of Surgery, Kasturba Medical College, Manipal University , India .
authors.forename: Alfred Joseph
authors.initials: AJ
authors.lastname: Augustine
authors.affiliation: Assistant Professor, Senior Scale, Department of Physiotherapy, Kasturba Medical College, Manipal University , India .
authors.forename: Zulfeequer Chundaanveetil
authors.initials: ZC
authors.lastname: Pazhyaottayil
authors.affiliation: Associate Dean and Professor, Department of Pulmonary Medicine, Kasturba Medical College, Manipal University , India .
authors.forename: Anand
authors.initials: A
authors.lastname: Ramakrishna
authors.affiliation: Assistant Professor, Senior Scale, Department of Physiotherapy, Kasturba Medical College, Manipal University , India .
authors.forename: Shyam Krishnan
authors.initials: SK
authors.lastname: Krishnakumar
keywords: Incentive spirometer; Laparotomy; Lung function test; Six-Minute Walk Test