| 1. |
- Westerdahl, Elisabeth, 1964-
(author)
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Effects of Deep Breathing Exercises after Coronary Artery Bypass Surgery
- 2004
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Doctoral thesis (other academic/artistic)abstract
- Deep breathing exercises are widely used in the postoperative care to prevent or reduce pulmonary complications, but no scientific evidence for the efficacy has been found after coronary artery bypass grafting (CABG) surgery. The aim of the thesis was to describe postoperative pulmonary function and to evaluate the efficacy of deep breathing exercises performed with or without a blow bottle device for positive expiratory pressure (PEP) 10 cmH2O or an inspiratory resistance-positive expiratory pressure (IR-PEP) mask with an inspiratory pressure of -5 cmH2O and an expiratory pressure of +10 to +15 cmH2O. Patients undergoing CABG were instructed to perform 30 slow deep breaths hourly during daytime for the first four postoperative days. Patient management was similar in the groups, except for the different breathing techniques. Measurements were performed preoperatively, on the fourth postoperative day and four months after surgery. The immediate effect of the deep breathing exercises was examined on the second postoperative day. Pulmonary function was assessed by spirometry, diffusion capacity for carbon monoxide and arterial blood gases. Atelectasis was determined by chest roentgenograms or spiral computed tomography (CT). Lung volumes were markedly reduced on the fourth postoperative day. Four months after surgery the pulmonary function was still significantly reduced. On the second and fourth postoperative day all patients had atelectasis visible on CT. A single session of deep breathing exercises performed with or without a mechanical device caused a significant reduction in atelectasis and an improvement in oxygenation. No major differences between deep breathing performed with or without a blow bottle or IR-PEP-device were found, except for a lesser decrease in total lung capacity in the blow bottle group on the fourth postoperative day. Patients who performed deep breathing exercises after CABG had significantly smaller atelectasis and better pulmonary function on the fourth postoperative day compared to a control group who performed no exercises.
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| 2. |
- Anderzén-Carlsson, Agneta, 1966-, et al.
(author)
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Medical yoga : another way of being in the world-A phenomenological study from the perspective of persons suffering from stress-related symptoms
- 2014
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In: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 9
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Journal article (peer-reviewed)abstract
- The prevalence of stress-related illness has grown in recent years. Many of these patients seek help in primary health care. Yoga can reduce stress and thus complements pharmacological therapy in medical practice. To our knowledge, no studies have investigated patients' experiences of yoga treatment in a primary health care setting or, specifically, the experiences of yoga when suffering from stress-related illness. Thus, the aim of the present study was to explore the meaning of participating in medical yoga as a complementary treatment for stress-related symptoms and diagnosis in a primary health care setting. This study has a descriptive phenomenological design and took place at a primary health care centre in Sweden during 2011. Five women and one man (43-51 years) participated. They were recruited from the intervention group (n = 18) in a randomized control trial, in which they had participated in a medical yoga group in addition to standard care for 12 weeks. Data were collected by means of qualitative interviews, and a phenomenological data analysis was conducted. The essential meaning of the medical yoga experience was that the medical yoga was not an endpoint of recovery but the start of a process towards an increased sense of wholeness. It was described as a way of alleviating suffering, and it provided the participants with a tool for dealing with their stress and current situation on a practical level. It led to greater self-awareness and self-esteem, which in turn had an implicit impact on their lifeworld. In phenomenological terms, this can be summarized as Another way of being in the world, encompassing a perception of deepened identity. From a philosophical perspective, due to using the body in a new way (yoga), the participants had learnt to see things differently, which enriched and recast their perception of themselves and their lives.
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| 3. |
- Westerdahl, Elisabeth, 1964-, et al.
(author)
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Deep breathing exercises performed 2 months following cardiac surgery : a randomized controlled trial
- 2014
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In: Journal of cardiopulmonary rehabilitation and prevention. - : Lippincott Williams & Wilkins. - 1932-7501 .- 1932-751X. ; 34:1, s. 34-42
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Journal article (peer-reviewed)abstract
- PURPOSE: Postoperative breathing exercises are recommended to cardiac surgery patients. Instructions concerning how long patients should continue exercises after discharge vary, and the significance of treatment needs to be determined. Our aim was to assess the effects of home-based deep breathing exercises performed with a positive expiratory pressure device for 2 months following cardiac surgery.METHODS: The study design was a prospective, single-blinded, parallel-group, randomized trial. Patients performing breathing exercises 2 months after cardiac surgery (n = 159) were compared with a control group (n = 154) performing no breathing exercises after discharge. The intervention consisted of 30 slow deep breaths performed with a positive expiratory pressure device (10-15 cm H2O), 5 times a day, during the first 2 months after surgery. The outcomes were lung function measurements, oxygen saturation, thoracic excursion mobility, subjective perception of breathing and pain, patient-perceived quality of recovery (40-Item Quality of Recovery score), health-related quality of life (36-Item Short Form Health Survey), and self-reported respiratory tract infection/pneumonia and antibiotic treatment.RESULTS: Two months postoperatively, the patients had significantly reduced lung function, with a mean decrease in forced expiratory volume in 1 second to 93 ± 12% (P< .001) of preoperative values. Oxygenation had returned to preoperative values, and 5 of 8 aspects in the 36-Item Short Form Health Survey were improved compared with preoperative values (P< .01). There were no significant differences between the groups in any of the measured outcomes.CONCLUSION: No significant differences in lung function, subjective perceptions, or quality of life were found between patients performing home-based deep breathing exercises and control patients 2 months after cardiac surgery.
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| 4. |
- Westerdahl, Elisabeth, 1964-, et al.
(author)
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First initiation of mobilization out of bed after cardiac surgery : an observational cross-sectional study in Sweden
- 2024
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In: Journal of Cardiothoracic Surgery. - : BioMed Central (BMC). - 1749-8090. ; 19:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: Cardiac surgery is associated with a period of postoperative bed rest. Although early mobilization is a vital component of postoperative care, for preventing complications and enhancing physical recovery, there is limited data on routine practices and optimal strategies for early mobilization after cardiac surgery. The aim of the study was to define the timing for the first initiation of out of bed mobilization after cardiac surgery and to describe the type of mobilization performed.METHODS: In this observational study, the first mobilization out of bed was studied in a subset of adult cardiac surgery patients (n = 290) from five of the eight university hospitals performing cardiothoracic surgery in Sweden. Over a five-week period, patients were evaluated for mobilization routines within the initial 24 h after cardiac surgery. Data on the timing of the first mobilization after the end of surgery, as well as the duration and type of mobilization, were documented. Additionally, information on patient characteristics, anesthesia, and surgery was collected.RESULTS: A total of 277 patients (96%) were mobilized out of bed within the first 24 h, and 39% of these patients were mobilized within 6 h after surgery. The time to first mobilization after the end of surgery was 8.7 ± 5.5 h; median of 7.1 [4.5-13.1] hours, with no significant differences between coronary artery bypass grafting, valve surgery, aortic surgery or other procedures (p = 0.156). First mobilization session lasted 20 ± 41 min with median of 10 [1-11]. Various kinds of first-time mobilization, including sitting on the edge of the bed, standing, and sitting in a chair, were revealed. A moderate association was found between longer intubation time and later first mobilization (ρ = 0.487, p < 0.001). Additionally, there was a moderate correlation between the first timing of mobilization duration of the first mobilization session (ρ = 0.315, p < 0.001).CONCLUSIONS: This study demonstrates a median time to first mobilization out of bed of 7 h after cardiac surgery. A moderate correlation was observed between earlier timing of mobilization and shorter duration of the mobilization session. Future research should explore reasons for delayed mobilization and investigate whether earlier mobilization correlates with clinical benefits.TRIAL REGISTRATION: FoU in VGR (Id 275,357) and Clinical Trials (NCT04729634).
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| 5. |
- Brocki, Barbara Cristina, 1957-, et al.
(author)
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Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery : a randomized controlled trial
- 2016
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In: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press. - 1010-7940 .- 1873-734X. ; 49:5, s. 1483-1491
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Journal article (peer-reviewed)abstract
- OBJECTIVES The aim was to investigate whether 2 weeks of inspiratory muscle training (IMT) could preserve respiratory muscle strength in high-risk patients referred for pulmonary resection on the suspicion of or confirmed lung cancer. Secondarily, we investigated the effect of the intervention on the incidence of postoperative pulmonary complications.METHODS The study was a single-centre, parallel-group, randomized trial with assessor blinding and intention-to-treat analysis. The intervention group (IG, n = 34) underwent 2 weeks of postoperative IMT twice daily with 2 × 30 breaths on a target intensity of 30% of maximal inspiratory pressure, in addition to standard postoperative physiotherapy. Standard physiotherapy in the control group (CG, n = 34) consisted of breathing exercises, coughing techniques and early mobilization. We measured respiratory muscle strength (maximal inspiratory/expiratory pressure, MIP/MEP), functional performance (6-min walk test), spirometry and peripheral oxygen saturation (SpO2), assessed the day before surgery and again 3–5 days and 2 weeks postoperatively. Postoperative pulmonary complications were evaluated 2 weeks after surgery.RESULTS The mean age was 70 ± 8 years and 57.5% were males. Thoracotomy was performed in 48.5% (n = 33) of cases. No effect of the intervention was found regarding MIP, MEP, lung volumes or functional performance at any time point. The overall incidence of pneumonia was 13% (n = 9), with no significant difference between groups [IG 6% (n = 2), CG 21% (n = 7), P = 0.14]. An improved SpO2 was found in the IG on the third and fourth postoperative days (Day 3: IG 93.8 ± 3.4 vs CG 91.9 ± 4.1%, P = 0.058; Day 4: IG 93.5 ± 3.5 vs CG 91 ± 3.9%, P = 0.02). We found no association between surgical procedure (thoracotomy versus thoracoscopy) and respiratory muscle strength, which was recovered in both groups 2 weeks after surgery.CONCLUSIONS Two weeks of additional postoperative IMT, compared with standard physiotherapy alone, did not preserve respiratory muscle strength but improved oxygenation in high-risk patients after lung cancer surgery. Respiratory muscle strength recovered in both groups 2 weeks after surgery.
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| 6. |
- Fagevik Olsén, Monika, 1964, et al.
(author)
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Positive Expiratory Pressure in Patients with Chronic Obstructive Pulmonary Disease - A Systematic Review.
- 2009
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In: Respiration; international review of thoracic diseases. - : S. Karger AG. - 1423-0356 .- 0025-7931. ; 77:1, s. 110-18
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Journal article (peer-reviewed)abstract
- Background: Breathing exercises against a resistance during expiration are often used as treatment for patients with chronic obstructive pulmonary disease (COPD). Controversy still exists regarding the clinical application and efficacy. Objectives: The aim of this systematic review was to determine the effects of chest physiotherapy techniques with positive expiratory pressure (PEP) for the prevention and treatment of pulmonary impairment in adults with COPD. Methods: The review was conducted on randomised, controlled clinical trials in which breathing exercises with positive expiratory pressure were compared with other chest physical therapy techniques or with no treatment, in adult patients with COPD. A computer-assisted literature search of available databases from 1970 to January 2008 was performed. Two reviewers extracted data independently and assessed the trials systematically with an instrument for measuring methodological quality. Results: In total, 11 trials met the inclusion criteria, of which 5 reached an adequate level of internal validity. Several kinds of PEP techniques with a diversity of intensities and durations of treatment have been evaluated with different outcome measures and follow-up periods. Benefits of PEP were found in isolated outcome measures in separate studies with a follow-up period <1 month. Concerning long-term effects, the results are contradictory. Conclusion: Prior to widespread prescription of long-term PEP treatment, more research is required to establish the benefit of the technique in patients with COPD.
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| 7. |
- Brocki, Barbara Cristina, et al.
(author)
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Inspiratory Muscle Training in High-Risk Patients Following Lung Resection May Prevent a Postoperative Decline in Physical Activity Level
- 2018
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In: Integrative Cancer Therapies. - : Sage Publications. - 1534-7354 .- 1552-695X. ; 17:4, s. 1095-1102
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To describe postoperative self-reported physical activity (PA) level and assess the effects of 2 weeks of postoperative inspiratory muscle training (IMT) in patients at high risk for postoperative pulmonary complications following lung resection.METHODS: This is a descriptive study reporting supplementary data from a randomized controlled trial that included 68 patients (mean age = 70 ± 8 years), randomized to an intervention group (IG; n = 34) or a control group (CG; n = 34). The IG underwent 2 weeks of postoperative IMT added to a standard postoperative physiotherapy given to both groups. The standard physiotherapy consisted of breathing exercises, coughing techniques, and early mobilization. We evaluated self-reported physical activity (Physical Activity Scale 2.1 questionnaire) and health status (EuroQol EQ-5D-5L questionnaire), assessed the day before surgery and 2 weeks postoperatively.RESULTS: A significant percentage of the patients in the IG reported less sedentary activity 2 weeks postoperatively when compared with the CG (sedentary 6% vs 22%, low activity 56% vs 66%, moderate activity 38% vs 12%, respectively; P = .006). The mean difference in EQ-5D-5L between the IG and CG 2 weeks postoperatively was nonsignificant ( P = .80). The overall preoperative EQ-5D-5L index score for the study population was comparable to a reference population.CONCLUSION: Postoperative IMT seems to prevent a decline in PA level 2 weeks postoperatively in high-risk patients undergoing lung resection. More research is needed to confirm these findings.
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| 8. |
- Fjerbaek, Annette, et al.
(author)
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Change of position from a supine to a sitting position increases pulmonary function early after cardiac surgery
- 2020
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In: European Journal of Physiotherapy. - : Taylor & Francis. - 2167-9169 .- 2167-9177. ; 22:6, s. 313-317
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Journal article (peer-reviewed)abstract
- Purpose: The aim of this study was to describe changes in pulmonary function from the supine to the sitting position following cardiac surgery.Methods: In a descriptive before-after design, we used the Beacon Caresystem for measurement of alveolar ventilation (V-A). The Spiropalm 6MWT was used to measure tidal volume (Vt), inspiratory capacity (IC) and peripheral oxygen saturation (SpO(2)). Assessments were performed 2-3 days post-operatively with patients in the supine position and again with patients sitting in a chair.Results: Fifteen patients were included. Compared to the supine position, sitting in a chair significantly improved V-A by 20% (p<.000); Vt by 25% (p=.015); IC by 21% (p=.036) and SpO(2) by 0.9% (p=.018).Conclusion: Lung function including alveolar ventilation was improved in the sitting compared to the supine position and was accompanied by improved oxygenation after uncomplicated, elective cardiac surgery. Further research is warranted to describe the impact of changes in positions in patients who do not follow a standardised clinical pathway.
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| 9. |
- Jonsson, Marcus, 1977-, et al.
(author)
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Physiotherapy provided for patients undergoing thoracic surgery in Sweden - a national survey of practice
- 2023
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In: Physiotherapy Theory and Practice. - : Taylor & Francis. - 0959-3985 .- 1532-5040. ; , s. 1-7
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Patients undergoing thoracic surgery commonly receive perioperative physio-therapy, typically consisting of education, mobilization, breathing exercises, and mobility exercises. To date, no study has described physiotherapy practice for patients undergoing thoracic surgery in Sweden.PURPOSE: To investigate physiotherapy interventions for patients undergoing thoracic surgery in Sweden.METHODS: All physiotherapists currently working in thoracic surgery units in Sweden (n = 8) were eligible to participate. A survey was e-mailed to the physiotherapists, to determine physiotherapy interventions offered to patients undergoing thoracoscopy or open thoracic surgery. Of 21 physiotherapists, 13 (62%) responded, representing seven hospitals.RESULTS: Physiotherapists reported routinely providing preoperative education and postoperative treatment for all patients undergoing thoracic surgery. Breathing exercises and mobilization were usually initiated on the day of surgery or the first postoperative day. Common treatments were deep breathing exercises, with or without positive expiratory pressure, and airway clearance techniques. Upper limb and shoulder exercises were typically initiated on the first or second day after surgery. The most important factor reported to influence treatment choice was personal experience of the attending physiotherapist. No routine post-discharge rehabilitation was provided.CONCLUSION: Physiotherapists in Sweden reported routinely treating patients scheduled for thoracic surgery, both pre and postoperatively. Prehabilitation or post-discharge rehabilitation was not routinely provided.
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| 10. |
- Pettersson, Henrik, et al.
(author)
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Improved oxygenation during standing performance of deep breathing exercises with positive expiratory pressure after cardiac surgery : a randomized controlled trial
- 2015
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In: Journal of Rehabilitation Medicine. - : FOUNDATION REHABILITATION INFORMATION. - 1650-1977 .- 1651-2081. ; 47:8, s. 748-752
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Journal article (peer-reviewed)abstract
- Objective: Breathing exercises after cardiac surgery are often performed in a sitting position. It is unknown whether oxygenation would be better in the standing position. The aim of this study was to evaluate oxygenation and subjecfive breathing ability during sitting vs standing performance of deep breathing exercises on the second day after cardiac surgery.Methods: Patients undergoing coronary artery bypass grafting (n=189) were randomized to sitting (controls) or standing. Both groups performed 3 x 10 deep breaths with a positive expiratory pressure device. Peripheral oxygen saturation was measured before, directly after, and 15 min after the intervention. Subjective breathing ability, blood pressure, heart rate, and pain were assessed.Results: Oxygenation improved significantly in the standing group compared with controls directly after the breathing exercises (p <0.001) and after 15 min rest (p=0.027). The standing group reported better deep breathing ability compared with controls (p=0.004). A slightly increased heart rate was found in the standing group (p= 0.047).Conclusion: After cardiac surgery, breathing exercises with positive expiratory pressure, performed in a standing position, significantly improved oxygenation and subjective breathing ability compared with sitting performance. Performance of breathing exercises in the standing position is feasible and could be a valuable treatment for patients with postoperative hypoxaemia.
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