A postoperative shoulder exercise program improves function and decreases pain following open thoracotomy: a randomised trial

• Published in: Journal of physiotherapy 2010, Vol.56 (4), p.245-252
• Main Authors: Reeve, Julie, Stiller, Kathy, Nicol, Kristine, McPherson, Kathryn M., Birch, Paul, Gordon, Ian R., Denehy, Linda
• Format: Article
• Language: English
• Subjects: Aged; Disability Evaluation; Exercise; Female; Follow-Up Studies; Humans; Lung - surgery; Male; Middle Aged; Muscle Strength - physiology; Pain; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Physical therapy (specialty); Physical Therapy Modalities; Postoperative complications; Postoperative pain; Quality of Life; Randomised controlled trial; Range of Motion, Articular - physiology; Shoulder; Shoulder Joint - physiology; Single-Blind Method; Thoracotomy; Thoracotomy - adverse effects
• ISSN: 1836-9553; 1836-9561
• DOI: 10.1016/S1836-9553(10)70007-2

Does a postoperative physiotherapy exercise program incorporating shoulder exercises improve shoulder function, pain, range of motion, muscle strength, and health-related quality of life in patients undergoing elective pulmonary resection via open thoracotomy? Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. 76 patients who underwent pulmonary resection via open thoracotomy. All participants received standard medical and nursing care involving a clinical pathway. The experimental group also received physiotherapy interventions that included daily supervised, progressive exercises until discharge and a postoperative exercise booklet on discharge. Preoperatively and up to 3 months postoperatively pain was measured with a numerical rating scale, shoulder function with the Shoulder Pain and Disability Index, and quality of life with the Short Form-36. Shoulder range of motion and muscle strength were measured in a subgroup. The experimental group had 1.3 units (95% CI 0.3 to 2.2) less shoulder pain (scored /10) and 2.2 units (95% CI 0.2 to 4.3) less total pain (scored /30) at discharge, and 7.6% (95% CI 1.7 to 13.6) better function at 3 months. The Short Form-36 physical component score was 4.8 points (95% CI –0.3 to 10.0) better for the experimental group than the control group at 3 months. Differences between groups in all range of motion and strength measures were small and statistically non-significant. A physiotherapist-directed postoperative exercise program resulted in significant benefits in pain and shoulder function over usual care for patients following open thoracotomy. ANZCTRN 12605000201673.