A postoperative shoulder exercise program improves function and decreases pain following open thoracotomy: a randomised trial.

Abstract

QUESTION:

Does a postoperative physiotherapy exercise program incorporating shoulder exercises improve shoulder function, pain, range of motion, muscle strength, and health-related quality of life in patients undergoing elective pulmonary resection via open thoracotomy?

DESIGN:

Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis.

PARTICIPANTS:

76 patients who underwent pulmonary resection via open thoracotomy.

INTERVENTION:

All participants received standard medical and nursing care involving a clinical pathway. The experimental group also received physiotherapy interventions that included daily supervised, progressive exercises until discharge and a postoperative exercise booklet on discharge.

OUTCOME MEASURES:

Preoperatively and up to 3 months postoperatively pain was measured with a numerical rating scale, shoulder function with the Shoulder Pain and Disability Index, and quality of life with the Short Form-36. Shoulder range of motion and muscle strength were measured in a subgroup.

RESULTS:

The experimental group had 1.3 units (95% CI 0.3 to 2.2) less shoulder pain (scored /10) and 2.2 units (95% CI 0.2 to 4.3) less total pain (scored /30) at discharge, and 7.6% (95% CI 1.7 to 13.6) better function at 3 months. The Short Form-36 physical component score was 4.8 points (95% CI -0.3 to 10.0) better for the experimental group than the control group at 3 months. Differences between groups in all range of motion and strength measures were small and statistically non-significant.

CONCLUSION:

A physiotherapist-directed postoperative exercise program resulted in significant benefits in pain and shoulder function over usual care for patients following open thoracotomy.

TRIAL REGISTRATION:

ANZCTRN 12605000201673.

• Authors: Julie Reeve, Kathy Stiller, Kristine Nicol, Kathryn M McPherson, Paul Birch, Ian R Gordon, Linda Denehy
• Journal: Journal of physiotherapy (J Physiother) Vol. 56 Issue 4 Pg. 245-52 ( 2010) ISSN: 1836-9553 [Print] Netherlands
• PMID: 21091414 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Disability Evaluation
• Female
• Follow-Up Studies
• Humans
• Lung (surgery)
• Male
• Middle Aged
• Muscle Strength (physiology)
• Pain, Postoperative (etiology, prevention & control)
• Physical Therapy Modalities
• Quality of Life
• Range of Motion, Articular (physiology)
• Shoulder Joint (physiology)
• Single-Blind Method
• Thoracotomy (adverse effects)