Association of Chartered Physiotherapists in Respiratory Care scoping review: Post-operative physiotherapy in people undergoing thoracic surgery

Introduction This scoping review was produced by the ACPRC editorial board. Following a preliminary scoping day, surgery was considered 1 of 5 key priorities for review. Surgery was subsequently separated into specialities. Objective The objective of this scoping review was to report the extent and methodological type of evidence associated with post-operative physiotherapy in people who underwent thoracic surgery. Inclusion criteria Studies with adult patients undergoing thoracic surgery and published between 2014 and 2020 were included. The thoracic procedure undertaken required post-operative physiotherapy intervention as part of the recovery process. Method Searches were undertaken in PEDro, CINAHL, EMBASE, MEDLINE, PubMed, Google Scholar and the Clinical Trials Registry. Article titles and abstracts were screened by one reviewer, and full text articles appraised by two reviewers. Quality was assessed and data was extracted using the relevant tools dependent on study methodology. Results Initially, 1809 articles were retrieved from which 28 articles were included in this scoping review, including a total of 6265 participants. Studies were randomised control trials (n = 10), observational studies (n = 7) and systematic review or meta-analysis (n = 5). The quality of the articles was good with the studies having structured protocols and blinding of subjects where appropriate, however there were some methodical flaws, including being underpowered. The variability in clinical physiotherapy practice between countries was highlighted. Included studies explored respiratory physiotherapy (n = 13), mobilisation (n = 10), combined respiratory and mobilisation (n = 3), kinesiology taping (n = 1) and outcomes (n = 1). Early and intensive mobilisation as part of an ERAS programme demonstrated statistically significant reduction in length of stay, post-operative pulmonary complications, and morbidity. The level of patients’ pre-operative mobility impacted on their post-operative outcomes and risk of developing post-operative pulmonary complications (PPC). Conclusion The scoping review included 28 studies with a range of methodologies providing evidence that supports post-operative physiotherapy intervention in people who undergo thoracic surgery. Future research should aim to clarify which respiratory physiotherapy techniques impact recovery and expand the diversity of methodologies to include more qualitative research.