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Ferraz A.1, Bartley A.1, Bunting C.1, Patman S.1
1University of Notre Dame Australia, School of Physiotherapy, Perth, Australia
Background: Postoperative pulmonary complications (PPCs) are one of the most frequent complications following upper abdominal surgery (UAS), ranging from rates of 9% to 40%. Physiotherapists prescribe early mobility to patients following UAS to optimise recovery and prevent development of PPCs. Consensus guidelines have been developed outlining parameters for mobility prescription following UAS and recommend prescribing mobility at an intensity of 6 on the modified Borg dyspnoea scale. Parameters and assessment tools utilised by physiotherapists to guide mobility prescription and whether they conform to the consensus guidelines is unknown.
Purpose: This study sought to identify what physiotherapists aimed to achieve through the prescription of mobility programs following UAS and to identify what assessment tools and outcome measures physiotherapists are using to prescribe the frequency, intensity, duration and rate of progression of mobilisation. Secondly, the study intended to see if there had been knowledge translation of the guidelines and current literature into practice.
Methods: A novel online anonymous de-novo survey was disseminated to 164 physiotherapists working in general surgical wards of Australian hospitals in which UAS was performed.
Results: Fifty-seven responses were received (35%). Mobilisation was found to be one of the key components of physiotherapy intervention following UAS, with the main aims on day one being associated with PPC prophylaxis. On day one, 80% of respondents expected patients to ambulate away from the bedside with assistance from staff. Oxygen saturations (SpO2), in addition to being used as an outcome measure and to monitor safety, was identified as the most frequently used parameter to guide decision-making and influenced the prescription of the frequency, intensity and duration of mobility. The Borg scale, maximum oxygen uptake (VO2 max) and evidence were used infrequently to prescribe mobility.
Conclusion(s): Physiotherapists are mobilising patients early following UAS with the aim of reducing PPCs. Results suggest an over-reliance upon SpO2 when prescribing mobility, and only partial translation of knowledge of current evidence and consensus guidelines into practice. More appropriate outcome measures, such as the Borg scales and VO2 max predictive questionnaires, could be used in conjunction with SpO2 to individualise mobility prescription and ensure physiological response to mobility postoperatively. Future research in other jurisdictions is warranted to establish if there are regional variances in practice, and it is recommended that investigating the optimum prescription frequency, intensity and duration of early mobilisation for patients following UAS to reduce rates of PPCs and /or improve outcomes in this population should be considered.
Implications: Despite the majority of physiotherapists mobilising patients early following UAS, they may not be prescribing mobility at an intensity that achieves adequate physiological response. As a profession, physiotherapists have adequate knowledge in regards to the physiological responses to exercise and should consider the application of this knowledge when treating and prescribing mobility to post-operative patients.
Funding acknowledgements: nil to report
Topic: Cardiorespiratory
Ethics approval: Approved by the Human Research Ethics Committee of The University of Notre Dame Australia (015151F).
All authors, affiliations and abstracts have been published as submitted.
