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N. Sharma1, A.J. Samuel1
1Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Pediatrics and Neonatal Physiotherapy, Ambala, India
Background: Postoperative pulmonary complications (PPC) are the most serious cause of morbidity and mortality after surgical procures. Various open pediatric thoracic, pelvic, musculoskeletal, and abdominal surgical procedures may lead to a decrease in pulmonary function and functional capacity, which further can cause serious PPC. Anesthesia and surgical duration suppress the cough reflex and reduce lung volumes which lead to PPC. Preoperative physiotherapy education (POPE) followed by postoperative physiotherapy (POP) plays a very important role in preventing PPC, preserving pulmonary function, and functional capacity. We intend to systematically summarize the available literature on physiotherapy in open pediatric surgical procedures.
Purpose: To examine the available literature on POPE following POP in increasing pulmonary function and functional capacity, and thereby minimizing the risks of PPC in various open pediatric surgical procedures.
Methods: A systematic online search was conducted through four databases, PubMed, PEDro, SCOPUS, and Web of science of published literature were searched from inception to 2020 for randomized controlled trials and quasi-experimental studies involving children aged 5-17 years. We have used search strategy including keywords: "abdominal surgery”, “chest physiotherapy”, “POPE”, “Six-minute walk test”, “Spirometry’, “Postoperative” and “Preoperative”. These words were used in combination with Boolean terms, “OR” and “AND”. Data were extracted from the included studies and assessed for risk of bias, and quality of evidence. Data available on these databases were only limited to the effects of POPE combined with POP in open pediatric surgeries.
Results: We have found physiotherapy interventions only on abdominal and cardiac surgeries among the pediatric population. The available studies have concluded that POPE improves lung function and functional performance after surgery. It also helps in minimizing the incidence of PPC. A total of two randomized controlled trials and one quasi-experimental study performed on the pediatric population were identified and included for the systematic review. The studies varied in outcome measures, sample size, quality, and duration of intervention and follow-up. Studies were tested for the risk of bias and quality assessment. According to PEDro criterion scoring, the studies obtained a scoring range of 6-9, are level 1b Sackett level of evidence, thus confirming the studies as a high quality randomized controlled trials. The studies were further tested for risk of bias using Cochrane risk of bias criteria, revealed moderate to low risk of bias.
Conclusion(s): POPE following POP after surgeries might help in improving pulmonary function and functional capacity, and further can also minimize the risks of PPC in various open pediatric surgical procedures. But, it should be further confirmed by large sample, randomized controlled trials.
Implications: Standardized physiotherapy protocols are available only for children undergoing open abdominal and cardiac surgeries. Physiotherapy protocols include POPE following POP, which should be made available for other open pediatric surgeries including thoracic, musculoskeletal, and pelvic surgeries for preserving pulmonary function and functional capacity after surgery.
Funding, acknowledgements: None
Keywords: Surgery, Physiotherapy, Post operative rehabilitation
Topic: Paediatrics
Did this work require ethics approval? No
Institution: Maharishi Markandeshwar Institute of physiotherapy and Rehabilitation
Committee: Maharishi Markandeshwar Institute of Medical Sciences and Research
Reason: Ethical approval is not required as it is a systematic review
All authors, affiliations and abstracts have been published as submitted.
