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Bartley A.1, Ferraz A.1, Bunting C.1, Patman S.1
1University of Notre Dame Australia, School of Physiotherapy, Perth, Australia
Background: Upper abdominal surgery (UAS) has the potential to cause post-operative pulmonary complications (PPCs), with reported incidence ranging from 9-40%. Variability in screening tools and interventions utilised by physiotherapists may impact patient outcomes such as PPC incidence and length of stay. In the absence of high-quality research regarding post-operative physiotherapy management, best practice guidelines formulated by Hanekom et al (2012) provide recommendations for physiotherapy management post-UAS treatment, including mobility and prophylactic chest treatment. Subsequent evidence suggests that mobilisation maybe sufficient as a standalone treatment in PPC prevention (Silva et al., 2013).
Purpose: This project aimed to document and report the assessment tools and intervention strategies physiotherapists are currently utilising following UAS, establishing whether current management is reflective of best practice guidelines and recent evidence. Also explored were the current perceived barriers to providing these interventions.
Methods: This novel, anonymous, online survey was designed to explore current physiotherapy practice for patients following UAS in general surgical wards in Australian hospitals.
All Australian hospitals performing UAS and providing a post-operative physiotherapy service (n=189) were targeted for contact details and/or email addresses of physiotherapists. The survey was distributed by email using the online survey tool Qualtrics (http://www.qualtrics.com). Categorical data were expressed in terms of count, frequency and proportions, primarily reporting percentages and means, specifically clarifying the total responses (n).
Results: Variability of screening tools used to identify post-operative patients at high risk of PPC development was evident. On day one when a patients condition is not limited, majority of physiotherapists routinely mobilise UAS patients. Additionally, routine chest treatment continues to be implemented, with only 23% (n=11/47) of physiotherapists mobilising patients without additional specific respiratory intervention. Patient-dependent factors such as non-compliance were among those identified as barriers to commencing treatment.
Conclusion(s): Physiotherapists indicated that early mobilisation away from the bedside was the preferred post-operative treatment within the UAS patient population. Current intervention choice is reflective of Hanekom et al. (2012) guidelines, however recent literature has called this into question and more research needs to be done to establish if these recommendations are the most effective at reducing PPCs. Likewise, future work should focus on identification of barriers, the strategies used to overcome limitations and the creation of a reliable and validated screening tool to ensure appropriate prioritisation and allocation of physiotherapy resources within the UAS patient population.
Implications: This survey provides a summary of current physiotherapy practice in the UAS population in Australia, highlighting the gaps in knowledge and providing an opportunity for future research.
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.
