Physical function and activity of patients after open abdominal surgery: a prospective cohort study comparing the clinimetric properties of two outcome measures.

OBJECTIVES: To measure and compare the clinimetric properties of the Chelsea Critical Care Physical Assessment (CPAx) and Physical Function in Intensive Care Test-scored (PFIT-s) for assessment of physical function and activity. DESIGN: Prospective cohort design using crossover-randomisation of the sequence in which participants were assessed with CPAx and PFIT-s. SETTING: Surgical and transplant intensive care units (ICU) in an academic hospital. PARTICIPANTS: Adults who underwent elective open abdominal surgery. Consecutive sampling was used to enrol 69 participants. INTERVENTIONS: Physical function and activity were assessed on ICU days one, three, five and at ICU discharge using the CPAx and PFIT-s in random order. MAIN OUTCOME MEASURES: Responsiveness to change, minimal clinically important difference (MCID), floor and ceiling effect, and convergent validity. RESULTS: CPAx demonstrated a large responsiveness (effect size index (ESI)= 0.83) and PFIT-s moderate responsiveness (ESI=0.73) to change in scores. MCID for CPAx was 2.1 (standard error of measurement (SEM) 1.1) and for PFIT-s 0.6 (SEM=0.3). CPAx had no floor effect and a small ceiling effect (9%, n = 6) at ICU discharge compared to 2% (n = 1) floor and 48% (n = 32) ceiling effects of PFIT-s. Moderate convergent validity was found for both tools at ICU admission (n = 67, r = 0.62, p < 0.001) and discharge (n = 67, r = 0.51, p < 0.001). CONCLUSION: CPAx is most responsive to changes in physical function and activity scores, has no floor and limited ceiling effects and moderate convergent validity, and is recommended for similar cohorts. CONTRIBUTION OF THE PAPER.

Preoperative physiotherapy education for patients undergoing colorectal cancer resection.

BACKGROUND: Surgical resection is a common treatment for patients with colorectal cancer. Patients undergoing surgery are at risk of functional deterioration as a response to surgical stress. Furthermore, patients with cancer often present with systemic problems as well as a functional decline. The study aimed to create a framework for preoperative education for patients undergoing colorectal cancer resection. METHODS: Five databases were utilised to find intervention-based studies describing the content, mode, setting and timing of delivery of preoperative education for patients undergoing abdominal surgery. Physiotherapists were purposively sampled to participate in a focus group session using a seven-step nominal group technique (NGT) with the goal to reach consensus on the proposed content of a preoperative patient education programme. RESULTS: Seventeen studies were reviewed. Results indicate that the mode and timing of the education provided are heterogenous. Content included in the education programs described were breathing exercises, coughing techniques, verbal advice, physical exercises, surgical information, postoperative pain management, nutritional support, relaxation techniques and information about postoperative complications. Six physiotherapists participated in the focus group discussion. Ideas generated in the focus group were similar to those described in the literature. CONCLUSION: Results from both the narrative review and the focus group session assisted the authors to develop a framework for the content, timing, setting and mode of delivery of physiotherapy preoperative education for patients undergoing surgical resection for colorectal cancer.Contribution: The framework can be used to inform a physiotherapy preoperative education programme for patients undergoing surgery for colorectal cancer.

Outcome of survivors of COVID-19 in the intermediate phase of recovery: A case report.

Introduction: Coronavirus disease 2019 (COVID-19) is a viral respiratory disease and is associated with significant morbidity in the intermediate and chronic phases of recovery from the disease. The health benefits of respiratory and extremity muscle strengthening exercise therapy are well-described for those with cardiac failure and interstitial lung disease and are suggested to improve functional ability for patients recovering from COVID-19. The aim of this case report is to share the effects of standard physiotherapy management on exercise endurance, respiratory function and return to work, implemented for patients with COVID-19 in the intermediate phase of their recovery. Patient presentation: Two cases of COVID-19 were admitted to a private healthcare facility in Johannesburg. They presented with shortness of breath and decreased endurance. One had COVID-19 myocarditis and the other chronic post-COVID-19 organising pneumonia with pulmonary fibrosis. Management and outcome: Both patients were admitted to ICU, provided oxygen therapy and supportive care as well as physiotherapy management in hospital and after hospital discharge. Physiotherapy management included inspiratory muscle training therapy, and cardiovascular and resistance exercise therapy. Improvements in peak expiratory flow rate and six-minute walk distance were observed for both cases at 6- and 7-months follow-up, respectively. Conclusion: Our case report illustrates the value of ongoing physiotherapy management, utilising progressive exercise therapy prescription, to aid the return to optimal functioning for survivors of COVID-19 in the intermediate phase of their recovery.