Intervention Review

Preoperative physical therapy for elective cardiac surgery patients

  1. Erik HJ Hulzebos1,*,
  2. Yolba Smit2,
  3. Paul PJM Helders3,
  4. Nico LU van Meeteren4

Editorial Group: Cochrane Heart Group

Published Online: 14 NOV 2012

Assessed as up-to-date: 11 DEC 2011

DOI: 10.1002/14651858.CD010118.pub2


How to Cite

Hulzebos EHJ, Smit Y, Helders PPJM, van Meeteren NLU. Preoperative physical therapy for elective cardiac surgery patients. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD010118. DOI: 10.1002/14651858.CD010118.pub2.

Author Information

  1. 1

    University Children's Hospital and Medical Center Utrecht, Department of Child Development and Exercise Center, Utrecht, Netherlands

  2. 2

    c/o Cochrane Heart Group, London, UK

  3. 3

    University Medical Center Utrecht, Department of Pediatric Physical Therapy & Exercise Physiology, Utrecht, Netherlands

  4. 4

    Netherlands Organisation for Applied Scientific Research TNO, Innovation area Healthy for Life, Leiden, Netherlands

*Erik HJ Hulzebos, Department of Child Development and Exercise Center, University Children's Hospital and Medical Center Utrecht, Room STR 5.133, PO Box 8550, Utrecht, 3508 GA, Netherlands. h.hulzebos@umcutrecht.nl.

Publication History

  1. Publication Status: Edited (no change to conclusions), comment added to review
  2. Published Online: 14 NOV 2012

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

After cardiac surgery, physical therapy is a routine procedure delivered with the aim of preventing postoperative pulmonary complications.

Objectives

To determine if preoperative physical therapy with an exercise component can prevent postoperative pulmonary complications in cardiac surgery patients, and to evaluate which type of patient benefits and which type of physical therapy is most effective.

Search methods

Searches were run on the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library (2011, Issue 12); MEDLINE (1966 to 12 December 2011); EMBASE (1980 to week 49, 2011); the Physical Therapy Evidence Database (PEDro) (to 12 December 2011) and CINAHL (1982 to 12 December 2011).

Selection criteria

Randomised controlled trials or quasi-randomised trials comparing preoperative physical therapy with no preoperative physical therapy or sham therapy in adult patients undergoing elective cardiac surgery.

Data collection and analysis

Data were collected on the type of study, participants, treatments used, primary outcomes (postoperative pulmonary complications grade 2 to 4: atelectasis, pneumonia, pneumothorax, mechanical ventilation > 48 hours, all-cause death, adverse events) and secondary outcomes (length of hospital stay, physical function measures, health-related quality of life, respiratory death, costs). Data were extracted by one review author and checked by a second review author. Review Manager 5.1 software was used for the analysis.

Main results

Eight randomised controlled trials with 856 patients were included. Three studies used a mixed intervention (including either aerobic exercises or breathing exercises); five studies used inspiratory muscle training. Only one study used sham training in the controls. Patients that received preoperative physical therapy had a reduced risk of postoperative atelectasis (four studies including 379 participants, relative risk (RR) 0.52; 95% CI 0.32 to 0.87; P = 0.01) and pneumonia (five studies including 448 participants, RR 0.45; 95% CI 0.24 to 0.83; P = 0.01) but not of pneumothorax (one study with 45 participants, RR 0.12; 95% CI 0.01 to 2.11; P = 0.15) or mechanical ventilation for > 48 hours after surgery (two studies with 306 participants, RR 0.55; 95% CI 0.03 to 9.20; P = 0.68). Postoperative death from all causes did not differ between groups (three studies with 552 participants, RR 0.66; 95% CI 0.02 to 18.48; P = 0.81). Adverse events were not detected in the three studies that reported on them. The length of postoperative hospital stay was significantly shorter in experimental patients versus controls (three studies with 347 participants, mean difference -3.21 days; 95% CI -5.73 to -0.69; P = 0.01). One study reported an increased physical function measure on the six-minute walking test in experimental patients compared to controls. One other study reported a better health-related quality of life in experimental patients compared to controls. Postoperative death from respiratory causes did not differ between groups (one study with 276 participants, RR 0.14; 95% CI 0.01 to 2.70; P = 0.19). Cost data were not reported on.

Authors' conclusions

Evidence derived from small trials suggests that preoperative physical therapy reduces postoperative pulmonary complications (atelectasis and pneumonia) and length of hospital stay in patients undergoing elective cardiac surgery. There is a lack of evidence that preoperative physical therapy reduces postoperative pneumothorax, prolonged mechanical ventilation or all-cause deaths.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Preoperative physical therapy for elective cardiac surgery patients

Patients undergoing cardiac surgery are at risk of postoperative pulmonary complications such as pneumonia. These complications prolong postoperative recovery and may even lead to death. Increased physical fitness improves people's functional capacity, including their lungs, and could result in individuals being better prepared to withstand the consequences of the physical stress of surgery.

The authors of this review evaluated the efficacy and safety of preoperative physical therapy with an exercise component in cardiac surgery patients. From the pertinent literature, eight studies met the inclusion criteria, comprising a total of 856 participants. The results showed that preoperative physical therapy reduced the number of patients who experienced atelectasis or pneumonia but not the number of patients who experienced pneumothorax, prolonged ventilation or postoperative death. Patients who had preoperative physical therapy had an earlier (on average by more than three days) discharge from the hospital. Information on adverse events was limited but those studies that did report on adverse events reported none. None of the studies reported on the costs of preoperative physical therapy.

The authors concluded that preoperative physical therapy, especially inspiratory muscle training, prevents some postoperative complications including atelectasis, pneumonia, and length of hospital stay.