This study evaluates the effect of a training intervention after thoracoabdominal resection of the oesophagus. Half of the patients scheduled for thoracoabdominal oesophagus surgery were randomized to an intervention group while the other half a control group.
It is well known that thoracoabdominal oesophageal resection for cancer is a procedure with high risks for complications. Earlier trials have shown that respiratory restrictions persist after the operation as well as lower physical function, range of motion in the rib-cage and limitations in activities in daily living. There are, however, only two clinical studies that evaluate postoperative breathing exercises and none evaluating any other rehabilitation interventions. In other types of extensive surgery that may affect mobility with trauma to muscles and bone structures in the thorax and thoracic spinal column, there is strong evidence that speaks for an active rehabilitation approach in favour of a less active one. The intervention evaluated was a rehabilitation program including exercises to restore lung function, range of motion in the thoracic spine and shoulders and strength exercises for the back extensors, shoulders and legs.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
64
After 1 week * Chest expansions * Static thoracic extension in prone * Lateral flexion of the spine in standing * Bilateral shoulder flexion * Shoulder external rotation of shoulders * Rotation of the thoracic spine in sitting * Static back extensor strength in prone After 1 month * Thoracic extension, rotation and flexion abduction * Hand in neck and in back * Bilateral active flexion abduction * Strength training of leg muscles * Static back extensor strength After 2 months * Strength training of legs and back muscles * Push-ups against a wall * Thoracic extension in sitting and standing * Thoracic rotation in lying * Stretching of mm. pectoralis Training was performed daily with 10 rep of each exercise
Degree of physical disability estimated by the Disability Rating Index (DRI)
12 items covering activities from dressing and going for walks to lifting heavy objects and exercising. The item responses were rated on visual analogue scales (0-100)
Time frame: 3 months
Pain in the neck, rib cage and shoulders (visual analogue scale)
Estimated on a 100-mm visual analogue scale
Time frame: 3 months
FVC (Forced Vital Capacity)
Forced Vital Capacity performed in a standardised manner
Time frame: 3 months
Range of motion
Thorax expansion, back flexion, extension and lateral flexion, shoulder flexion and abduction
Time frame: 3 months
Physical function (Time stand test and heel rise test)
Time stand test and heel rise test
Time frame: 3 months
Physical Activity (six-level scale)
A six-level scale where low figures indicate a sedentary and a high score an active lifestyle according to Grimby et al
Time frame: 3 months
Quality of Life by EORTC QLQ-C30
European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core -30 version 3.0. All responses were converted to a score of between 0 and 100 using a linear transformation following EORTC guidelines (EORTC). High scores indicate good functioning but a high level of symptoms
Time frame: 3 months
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FEV1 s
Forced performed in a standardised manner
Time frame: 3 months
PEF (Peak Expiratory Flow)
Peak Expiratory Flow performed in a standardised manner
Time frame: 3 months