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A. Grigoriadou1, F. Skamagkoulis1, K. Grigoriadis2, D. Dougenis3, G. Pepera1
1University of Thessaly, Clinical Exercise Physiology and Rehabilitation Laboratory, Lamia, Greece, 2Attikon University Hospital, Physiotherapy Department, Athens, Greece, 3National and Kapodistrian University of Athens, Medical School, Athens, Greece
Background: The use of Positive Expiratory Pressure (PEP) devices is considered beneficial for patients undergone abdominal and thoracic surgery. The access to the classic PEP devices is not always available. The use of alternative PEP devices is popular in physiotherapy. Water bottles, gloves or oxygen tubes are some of them. A possible alternative PEP device, cheaper, easier to find as well as to use, could be a simple drinking straw.
Purpose: The aim of this study was to represent the inhospital cardiorespiratory rehabilitation of a clinical trial and it was performed to test the suitability and the effect of a soft drink straw as an alternative PEP device on patients undergone a thoracic surgery. The present study is the first to examine the "soft drink" device and effect on cardiorespiratory parameters.
Methods: A cross-sectional transition, single-blinded, randomized study design (NCT04447586, ClinicalTrials.gov) was used. 13 adult patients who had undergone thoracic surgery were participated. The first part of the study performed to investigate the suitable command for exhalation through a device consisted of a drinking straw of a certain inner diameter (5mm), a disposable mouthpiece and a manometer. The suitable command came up by comparing the developing pressures within the therapeutic range of pressure (10-20 cmH2O). In the second part of the study eight patients (IG) from the overall sample who were selected using the closed envelope method were asked to exhale as indicated by the already selected command, performing 3 sets of 10 repetitions though a simple drinking straw. A control group (CG) with patients following their usual care was employed for comparison purposes.
Results: There was a strong statistical significance difference [p=0.012 (95% CI, 8.55 to 1.29), t(12) = 2.955] between the mean values of the 2 examined commands. A mixed between-within subjects analysis of variance was conducted to assess the impact of two different interventions (excale exercise repetitions through a drinking straw, usual care) on patients’ expiratory cough flow, across two periods (pre-intervention, post-intervention). There was no significant interaction between program, type of intervention and time, Wilks Lambda=0.89, F=(1, 11) = 1.43, p=0.26, partial eta squared=0.12. There was a substantial main effect for time, Wilks Lambda=1, F(1,11) = 5, p<0.005, partial eta squared=0.31, with both groups showing an improvement in expiratory cough flow. The main effect comparing the two types of intervention was significant, F (1,11) = 0.006, suggesting difference in the effectiveness of the two interventions.
Conclusion(s): Command B considered being the most suitable for exhaling through the selected straw. The difference between the mean values of the airflows before and after the intervention statistically significant but also therapeutically beneficial.
Implications: The improvement of the maximum cough flow is related with patient's ability to manage secretions, which is a risk reduction factor for patients undergone a thoracic surgery. A simple, soft drink straw might be a good, non-expensive, alternative PEP device and can be used as a mean of creating positive expiratory pressures.
Funding, acknowledgements: No funding to declare
Keywords: Soft drink straw, Alternative PEP device, thoracic surgery
Topic: Cardiorespiratory
Did this work require ethics approval? Yes
Institution: Physiotherapy Department, University of Thessaly
Committee: Ethics Committee of the University of Thessaly
Ethics number: 101ΣΕ2/16-01-2020)
All authors, affiliations and abstracts have been published as submitted.
