In patients undergoing lung cancer resection, postoperative rehabilitation interventions with breathing exercises may reduce atelectasis and improve lung function, according to findings published in BMC Pulmonary Medicine.
The systematic review and meta-analysis evaluated postoperative rehabilitation programs that included breathing exercises to determine whether they were effective for decreasing the incidence of atelectasis and improving lung function.
Researchers performed a literature search of the Cochrane Library, PubMed, EMBASE, and Web of Science databases for relevant studies published in English, as well as in the CNKI and Wanfang for Chinese studies, from 2012 to 2022.
Eligible studies were randomized controlled trials that included: participants with lung cancer who had any type of surgical resection; the incidence of pulmonary atelectasis as an outcome; and a comparison between patients receiving postoperative rehabilitation programs with breathing exercises at any intensity (the intervention group) vs those receiving a regular rehabilitation program (the control group).
The intervention group included postoperative rehabilitation programs that incorporated any breathing exercises as a component (eg, inspiratory muscle training, abdominal breathing training, and the use of assistive training devices related to breathing); regular rehabilitation programs included medication management, physiotherapy, and health education. The primary meta-analysis outcome was the incidence rate of atelectasis after surgery.
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Postoperative rehabilitation interventions that included breathing exercises decreased the incidence rate of atelectasis and improved lung function by increasing the FVC, FEV1, and FEV1/FVC ratio.
The meta-analysis included 7 studies with 569 participants. The effects of postoperative rehabilitation programs with breathing exercises on atelectasis were assessed by pooling data from all 7 trials. A fixed-effects model was used after no heterogeneity was observed. Overall, the researchers found that the incidence of atelectasis was significantly decreased in the intervention group (odds ratio [OR], 0.35; 95% CI, 0.18-0.67; I2 = 0%; P =.67) vs the control group.
With use of pooled data from 3 trials, according to a random effects model, the researchers found that postoperative rehabilitation programs improved forced vital capacity (FVC) score (mean difference [MD], 0.24; 95% CI, 0.07-0.41; I2 = 73%; P =.02). Analysis of forced expiratory volume in 1 second (FEV1) data from 5 trials found that the difference between the experimental group and intervention group was observed (MD, 0.31; 95% CI, 0.03-0.60; I2 = 98%; P <.01).
Pooled data from 2 trials were used to assess the effect of postoperative rehabilitation programs on the FEV1/FVC ratio. The findings showed that the programs can increase the grade of FEV1/ FVC ratio (MD, 9.09; 95% CI, 1.50-16.67; I2 = 94%; P <.01).
The main study limitation was the heterogeneity in the secondary outcomes of FVC, FEV1, and FEV1/FVC ratio. The quality of the evidence analyzed, with respect to potential performance bias and lack of blinding for outcome assessments, was also an issue. Furthermore, in 1 of the studies, the rehabilitation intervention was initiated 1 day before surgery.
“Postoperative rehabilitation interventions that included breathing exercises decreased the incidence rate of atelectasis and improved lung function by increasing the FVC, FEV1, and FEV1/FVC ratio,” the researchers concluded. However, they added that “We cannot deduce whether these breathing exercises will work independently from any other rehabilitation interventions.”
