pre and post PT -kk 3.pptx

pre and post operative physiotherapy

1. Physiotherapy in Pre and Post operative stage Dr. Kaushik Patel (MPT. PhD scholar) Assistant professor SPB Physiotherapy college

2. The incidence of pulmonary and circular complications is higher after abdominal surgery Physical therapy has a valuable role to play in prevention of respiratory and circulatory complications as well as their treatment Key Concepts Principles /Aims of physiotherapy Preoperative assessment Preoperative training Postoperative assessment Post operative training

3. Pulmonary complications were more frequent, were associated with longer hospital stay, and occurred in combination with cardiac complications in a substantial proportion of cases. Lawrence va , hilsenbeck sg , mulrow cd, dhanda r, sapp j, page cp. Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery. Journal of general internal medicine. 1995 dec 1;10(12):671-8.

4. Principles /Aims of physiotherapy

5. Steps of physiotherapy in abdominal surgery Preoperative physiotherapy Preoperative training

6. Preoperative physiotherapy Ideally patient should be admitted to the hospital 24 hours or more before the operation This allowed the patient to settle in and to meet those who are responsible for the surgery

7. Preoperative assessment Read the notes Assess the respiratory functions Check for circulatory problems Detailed history of the patient It include both subjective and objective assessment Benefits To gain good rapport To know the functional status To understand patients goals

8. a) Clinical notes reading Causes for surgery Comorbid conditions – like asthma, obesity, diabetes etc. Any other notes by the surgeon/ physician b) Respiratory assessment Chest deformities – Kyphosis, Kyphoscoliosis, pectusexcavatum and pectuscarninatum Breathing pattern – Normal rate Inspiration and Expiration ratio Abnormal breathing pattern – Pursed lip breathing Apnoea, Hypopnea Cheyne stokes respiration Ataxic breathing Apneustic breathing

9. Chest movements – Symmetry of chest movements Depth of respiration Accessory muscle involvement Chest expansion – B oth observational and palpation Dyspnoea/ Breathlessness – “The New York Heart Association Scale Of Dyspnoea” Orthopnoea – Breathless when lying flat “The New York Heart Association Scale Of Dyspnoea” I - N o symptoms with ordinary activity /Breathlessness with exertion II – Symptoms with ordinary activity III – Symptoms with mild exertion IV- Symptoms at rest

10. d) Circulatory assessment Homan’s test oedema- qualitative and quantitative both e) History taking Medical history Subjective history

11. Preoperative training Teach the patient any exercise that will be started during the very early postoperative period These often include.. Breathing exercise Cough reflex Arm and leg exercise Posture correction Benefits To educate and train the patient about the post operative exercise program and physiotherapy importance

12. a) Patient education Explain the general plan of care Pre operative instructions b) Breathing exercises Diaphragmatic and local expansion exercises c ) Cough Teach huffing and coughing technique

13. d) Arm exercises Short lever exercises Long lever exercises e) Leg exercises Ankle & toe movements Static Q’ceps & glutei f) Posture correction Advices Ergonomic advantages

14. Preoperative exercise therapy is effective for reducing both postoperative complication rates and length of hospital stay after cardiac or abdominal surgery (SR: valkenet , K. Et al., 2010) Valkenet , K. et al.  The effects of preoperative exercise therapy on postoperative outcome: a systematic review . Clinical Rehabilitation, Volume: 25 issue: 2, page(s): 99-111

15. Preoperative inspiratory muscle training reduced the incidence of postoperative pulmonary complications (such as actelectasis and pneumonia) and length of hospital stay compared with usual care in adults undergoing cardiac and major abdominal surgery( sr : katsura M, et al.,2015 )   Katsura M,  kuriyama A,  takeshima T,  fukuhara S,  furukawa TA. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane database of systematic reviews 2015, issue 10

16. Post-operative physiotherapy Aim To avoid respiratory and circulatory complication To prevent pressure sore To prevent muscle wasting and joint stiffness To prevent wound infection Scar management Postural awareness Complete rehabilitation in ADL

17. Post operative assessment (SOAP assessment format should be followed) Surgery notes reading Vital signs checking Understating the attachments Objective assessment Inspection of the surgical incision Benefit – To know the post operative problems of the patient

18. a) Surgery notes reading Type of incision Type of anaesthesia Duration of surgery Immediate complications/unwanted events/management b) Vital signs checking Pulse oximetry PR ECG Heart sounds Systemic arterial blood pressure CVP TPR chart Ventilator support Lungs volume ABG analysis

19. c) Understanding the attachments IV lines Nasogastric tube Catheter PCA- patient control anaesthesia Drains d) Orientation assessment Communication ability Alertness Perceptual ability to follow instructions

20. e) Objective assessment R espiratory Circulatory ROM/MUSCLE POWER Mobility/functional

21. Respiratory assessment Painful Breathing Difficulty In Coughing Impaired Respiration Accumulation Of Secretions Palpation Auscultation

22. ii) Circulatory assessment Homan’s sign Oedema iii) Posture & mobility Kypho scoliosis Bed mobility iv) Pain assessment VAS MPQ NPRS

23. Post operative training Benefits Early recovery and less hospital stay a) To prevent chest complication Breathing exercise (emphasis on lower segments) Coughing/cough support Inhalation , humidification & PD Breath control exercises with arm movements

24. b) To prevent circulatory complication Trendelenburg tilt ( 15 degree bed end elevation) Leg exercises Early ambulation Bed mobility Trunk &abs exercises Prevention by medical means e) Prevention of bad posture Firm back support Chair with arms Over correction

25. f ) To prevent muscle wasting and joint stiffness Strengthening exe to weak muscle Endurance training Encourage walking and increase distance gradually Stair climbing Ask the Patient to be as independent as possible. Immediately after surgery, encourage patient to move his limbs freely in full ROM. Relaxed passive movements. Active assisted exe. in full ROM then active movments .

26. g) Scar management Friction massage Modality like us. h) Complete rehabilitation in ADL

27. Chest physiotherapy during the immediate postoperative period following upper abdominal surgery are effective for improving oxygen-hemoglobin saturation without increased abdominal pain. Breathing exercises could be adopted at post-anesthesia care units with benefits for patients . Manzano RM, Carvalho CR, Saraiva-Romanholo BM, Vieira JE. Chest physiotherapy during immediate postoperative period among patients undergoing upper abdominal surgery: randomized clinical trial. Sao Paulo Medical Journal. 2008 Sep;126(5):269-73. .

28. The various techniques of physiotherapy (chest physiotherapy, incentive spirometry , continuous positive airway pressure breathing) seem to be equivalent in efficacy; but intermittent positive pressure breathing has no advantages, compared with the other treatments and could even be deleterious. Chest physiotherapy and incentive spirometry are the most practical methods available for decreasing secretion contents of airways, whereas continuous positive airway pressure breathing is efficient on atelectasis . Rezaiguia S, Jayr C. [Prevention of respiratory complications after abdominal surgery] Annales Francaises D'anesthesie et de Reanimation. 1996 ;15(5):623-646 .

29. Physiotherapy interventions are likely to have a positive impact across a range of outcomes including pain, qol , physical function and depression. Physiotherapy interventions are likely to be effective in the management of adults with Persistent post-surgical pain (PPSP ) . Robinson A, McIntosh J, Peberdy H, Wishart D, Brown G, Pope H, Kumar S. The effectiveness of physiotherapy interventions on pain and quality of life in adults with persistent post-surgical pain compared to usual care: A systematic review. PloS one. 2019 Dec 13;14(12):e0226227.