title: Evidence regarding patient compliance with incentive spirometry interventions after cardiac, thoracic and abdominal surgeries: A systematic literature review.
abstract: BACKGROUND
  Evidence regarding the effectiveness of incentive spirometry (ISy) on postoperative pulmonary outcomes after thoracic, cardiac and abdominal surgery remains inconclusive. This is attributed to various methodological issues inherent in ISy trials. Patient compliance has also been highlighted as a possible confounding factor; however, the status of evidence regarding patient compliance in these trials is unknown.
  
  
  OBJECTIVE
  To explore the status of evidence on patient compliance with ISy interventions in randomized controlled trials (RCTs) in the above contexts.
  
  
  METHODS
  A systematic search using MEDLINE, EMBASE and CINAHL databases was conducted to obtain relevant RCTs from 1972 to 2015 using the inclusion criteria. These were examined for specific ISy parameters, methods used for determining compliance and reporting on compliance. Main outcome measures were comparison of ISy parameters prescribed and assessed, and reporting on compliance.
  
  
  RESULTS
  Thirty-six relevant RCTs were obtained. Six ISy parameters were identified in ISy prescriptions from these trials. Almost all (97.2%) of the trials had ISy prescriptions with specific parameters. Wilcoxon signed-rank test revealed that the ISy parameters assessed were significantly lower (Z=-5.433; P<0.001) than those prescribed; 66.7% of the trials indicated use of various methods to assess these parameters. Only six (16.7%) trials included reports on compliance; however, these were also incomprehensive.
  
  
  CONCLUSIONS
  There is a scarcity and inconsistency of evidence regarding ISy compliance. Compliance data should be obtained using reliable and standardized methods to facilitate comparisons between and among trials. These should be reported comprehensively to facilitate valid inferences regarding ISy intervention effectiveness.
authors.affiliation: IJN-UTM Cardiovascular Engineering Centre, Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Johor Department of Clinical Sciences, Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia;
authors.forename: Aqilah Leela T
authors.initials: AL
authors.lastname: Narayanan
authors.affiliation: Department of Cardiothoracic Surgery, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia.
authors.forename: Syed Rasul G Syed
authors.initials: SR
authors.lastname: Hamid
authors.affiliation: IJN-UTM Cardiovascular Engineering Centre, Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Johor Department of Clinical Sciences, Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia;
authors.forename: Eko
authors.initials: E
authors.lastname: Supriyanto
keywords: Abdomen; Heart surgery; Incentive, Respiratory therapy; Spirometry; Thoracic surgery