Randomised Clinical Trial Pre-operative physiotherapy for elderly patients undergoing abdominal surgery

Rozelle Labuschagne, Ronel Roos

About the author(s) Rozelle Labuschagne, Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Ronel Roos, Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Abstract

Background: Elderly patients report a decrease in function and activities of daily living following abdominal surgery. The objectives of our pilot study were to determine the effects of a single pre-operative physiotherapy session consisting of education and exercise on clinical and physical function outcomes in elderly patients.

Methods/design: A single-blind pilot randomised controlled trial evaluated clinical and functional outcomes of elderly patients following surgery in a private hospital in Pretoria, South Africa. The outcomes included length of hospital stay (LOS), postoperative pulmonary complications (PPC), first mobilisation uptime, DeMorton Mobility Index (DEMMI), 6-minute walk test (6MWT), Lawton–Brody’s instrumental activities of daily living (IADL) and the Functional Comorbidity Index (FCI). Descriptive and inferential statistics were undertaken, and statistical significance was set at p ≤ 0.05.

Discussion: Twelve participants (n = 11 female [91.67%] and n = 1 [8.33%] male) with a mean age of 65.75 (±4.47) years were included. Most participants (n = 10, 83.33%) underwent lower abdominal laparotomy (n = 10, 83.33%). The median hospital LOS was n = 4 (IQR 3.25–4) days; walking distance at first mobilisation was 130 m (IQR (85–225), with intervention participants walking further (intervention: 177 m, IQR 100–242.50; control: 90, IQR 60 m – 245 m; p = 0.59). Recruitment was low, with only 10.95% referrals and 47.82% nonconsents.

Conclusion: A single physiotherapy session prior to surgery demonstrated a potential favourable change in elderly patients’ mobility postoperatively; however, further research is necessary.

Clinical implication: A once-off pre-operative physiotherapy session could enhance recovery in elderly patients.

Trial registration: Pan African Clinical Trial Registry, PACTR201809874713904, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3593

Keywords

abdominal surgery; DEMMI; elderly; function; pre-operative; prehabilitation; physiotherapy; 6-minute walk test

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