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Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection: a pilot randomized clinical trial
Morano MT, Araujo AS, Nascimento FAB, da Silva GPF, Mesquita R, Pinto JMS, de Moraes Filho MO, Pereira EED
Archives of Physical Medicine and Rehabilitation 2012 Jan;94(1):53-58
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To evaluate the effect of a 4-week pulmonary rehabilitation(PR) versus chest physical therapy(CPT) on the preoperative functional capacity and postoperative respiratory morbidity of patients undergoing lung cancer resection. DESIGN: Randomized single blinded study. SETTING: A teaching hospital. PARTICIPANTS: Patients undergoing lung cancer resection (n = 24). INTERVENTIONS: Patients were randomly assigned to receive pulmonary rehabilitation (strength and endurance training) versus chest physical therapy (breathing exercises for lung expansion). Both groups received educational classes. MAIN OUTCOME MEASURES: Functional parameters assessed before and after four weeks of PR or CPT (phase 1), and pulmonary complications assessed after lung cancer resection (phase 2). RESULTS: Twelve patients were randomized to PR arm and twelve to CPT arm. Three patients in the CPT arm were not submitted to lung resection due to inoperable cancer. During phase 1 evaluation most functional parameters in the PR group improved from baseline to one month: FVC in liters 1.47 (1.27 to 2.33) versus 1.71(1.65 to 2.80) respectively; p = 0.02), FVC% 62.5 (49 to 71) versus 76 (65 to 79.7) respectively; p < 0.05), 6 minute walk test (425.5 +/- 85.3 versus 475 +/- 86.5 meters respectively; p < 0.05), maximal inspiratory pressure (90 +/- 45.9 versus 117.5 +/- 36.5 cmH2O respectively; p < 0.05) and maximal expiratory pressure (79.7 +/- 17.1 versus 92.9 +/- 21.4 cmH2O respectively; p < 0.05). During phase 2 evaluation the incidence of postoperative respiratory morbidity was lower in the PR group (p = 0.01), the PR arm had shorter length of postoperative stay (12.2 +/- 3.6 versus 7.8 +/- 4.8 days respectively; p = 0.04) and fewer days needing a chest tube (7.4 +/- 2.6 versus 4.5 +/- 2.9 days respectively; p = 0.03) compared to the CPT arm. CONCLUSIONS: This result suggests that 4 weeks of pulmonary rehabilitation before lung cancer resection may improve preoperative functional capacity and decreases the postoperative respiratory morbidity.

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