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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* |
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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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