Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2012

Open Access 01-12-2012 | Research article

Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence

Authors: Susan D Hanekom, Dina Brooks, Linda Denehy, Monika Fagevik-Olsén, Timothy C Hardcastle, Shamila Manie, Quinette Louw

Published in: BMC Medical Informatics and Decision Making | Issue 1/2012

Login to get access

Abstract

Background

Postoperative pulmonary complications remain the most significant cause of morbidity following open upper abdominal surgery despite advances in perioperative care. However, due to the poor quality primary research uncertainty surrounding the value of prophylactic physiotherapy intervention in the management of patients following abdominal surgery persists. The Delphi process has been proposed as a pragmatic methodology to guide clinical practice when evidence is equivocal.

Methods

The objective was to develop a clinical management algorithm for the post operative management of abdominal surgery patients. Eleven draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by scientist clinicians (n = 5) in an electronic three round Delphi process. Algorithm statements which reached a priori defined consensus-semi-interquartile range (SIQR) < 0.5-were collated into the algorithm.

Results

The five panelists allocated to the abdominal surgery Delphi panel were from Australia, Canada, Sweden, and South Africa. The 11 draft algorithm statements were edited and 5 additional statements were formulated. The panel reached consensus on the rating of all statements. Four statements were rated essential.

Conclusion

An expert Delphi panel interpreted the equivocal evidence for the physiotherapeutic management of patients following upper abdominal surgery. Through a process of consensus a clinical management algorithm was formulated. This algorithm can now be used by clinicians to guide clinical practice in this population.
Appendix
Available only for authorised users
Literature
1.
Smetana GW: Postoperative pulmonary complications: an update on risk assessment and reduction. Cleve Clin J Med. 2009, 76 (Suppl 4): S60-5.CrossRefPubMed
2.
Dronkers J, Veldman A, Hoberg E, van der Waal C, van Meeteren N: Prevention of pulmonary complications after upper abdominal surgery by preoperative intensive inspiratory muscle training: a randomized controlled pilot study. Clin Rehabil. 2008, 22 (2): 134-142. 10.1177/0269215507081574.CrossRefPubMed
3.
Warner DO: Preventing postoperative pulmonary complications: the role of the anesthesiologist. Anesthesiology. 2000, 92 (5): 1467-1472. 10.1097/00000542-200005000-00037.CrossRefPubMed
4.
Brooks D, Parsons J, Newton J, Dear C, Silaj E, Sinclair L, Quirt J: Discharge criteria from perioperative physical therapy. Chest. 2002, 121 (2): 488-494. 10.1378/chest.121.2.488.CrossRefPubMed
5.
Denehy L, Carroll S, Ntoumenopoulos G, Jenkins S: A randomized controlled trial comparing periodic mask CPAP with physiotherapy after abdominal surgery. Physiother Res Int. 2001, 6 (4): 236-250. 10.1002/pri.231.CrossRefPubMed
6.
Mackay MR, Ellis E, Johnston C: Randomised clinical trial of physiotherapy after open abdominal surgery in high risk patients. Aust J Physiother. 2005, 51 (3): 151-159. 10.1016/S0004-9514(05)70021-0.CrossRefPubMed
7.
Bohner H, Kindgen-Milles D, Grust A, Buhl R, Lillotte WC, Muller BT, Muller E, Furst G, Sandmann W: Prophylactic nasal continuous positive airway pressure after major vascular surgery: results of a prospective randomized trial. Langenbecks Arch Surg. 2002, 387 (1): 21-26. 10.1007/s00423-002-0281-2.CrossRefPubMed
8.
Manzano RM, De Carvalho CRF, Saraiva-Romanholo BM, Vieira JE: Chest physiotherapy during immediate postoperative period among patients undergoing upper abdominal surgery: Randomized clinical trial. Sao Paulo Medical Journal. 2008, 126 (5): 269-273. 10.1590/S1516-31802008000500005.CrossRefPubMed
9.
Chumillas S, Ponce JL, Delgado F, Viciano V, Mateu M: Prevention of postoperative pulmonary complications through respiratory rehabilitation: a controlled clinical study. Arch Phys Med Rehabil. 1998, 79 (1): 5-9. 10.1016/S0003-9993(98)90198-8.CrossRefPubMed
10.
Fagevik Olsen M, Hahn I, Nordgren S, Lonroth H, Lundholm K, Marshall JC: Prophylactic chest physiotherapy reduced pulmonary complications after major abdominal surgery. Evidence-Based Medicine. 1998, 3 (4): 106-
11.
Fagevik Olsén M, Hahn I, Nordgren S, Lönroth H, Lundholm K: Randomized controlled trial of prophylactic chest physiotherapy in major abdominalsurgery. Br J Surg. 1997, 84: 1535-1538. 10.1002/bjs.1800841111.CrossRefPubMed
12.
Pasquina P, Tramer MR, Granier JM, Walder B: Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery: a systematic review. Chest. 2006, 130 (6): 1887-1899. 10.1378/chest.130.6.1887.CrossRefPubMed
13.
Overend TJ, Anderson CM, Lucy SD, Bhatia C, Jonsson BI, Timmermans C: The effect of incentive spirometry on postoperative pulmonary complications: a systematic review. Chest. 2001, 120 (3): 971-978. 10.1378/chest.120.3.971.CrossRefPubMed
14.
Thomas JA, McIntosh JM: Are incentive spirometry, intermittent positive pressure breathing, and deep breathing exercises effective in the prevention of postoperative pulmonary complications after upper abdominal surgery? A systematic overview and meta-analysis. Phys Ther. 1994, 74 (1): 3-10. discussion 10-6PubMed
15.
Lawrence VA, Cornell JE, Smetana GW, American College of Physicians: Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006, 144 (8): 596-608.CrossRefPubMed
16.
Conde M, Lawrence V: Perioperative care: Postoperative pulmonary infections. Clinical Evidence Concise. 2006, 15: 475-476.
17.
Örman J, Westerdahl E: Chest physiotherapy with positive expiratory pressure breathing after abdominal and thoracic surgery: A systematic review: Review Article. Acta Anaesthesiol Scand. 2010, 54 (3): 261-267. 10.1111/j.1399-6576.2009.02143.x.CrossRefPubMed
18.
Guimarães MM, El Dib R, Smith AF, Matos D: Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane database of systematic reviews (Online). 2009, 3
19.
Morris AH: Treatment algorithms and protocolized care. Curr Opin Crit Care. 2003, 9 (3): 236-240. 10.1097/00075198-200306000-00012.CrossRefPubMed
20.
Falkson CB, Bezjak A, Darling G, Gregg R, Malthaner R, Maziak DE, Yu E, Smith CA, McNair S, Ung YC, Evans WK, Lung Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-Based Care: The management of thymoma: a systematic review and practice guideline. J Thorac Oncol. 2009, 4 (7): 911-919. 10.1097/JTO.0b013e3181a4b8e0.CrossRefPubMed
21.
Dernis E, Lavie F, Pavy S, Wendling D, Flipo RM, Saraux A, Cantagrel A, Claudepierrre P, Goupille P, Le Loet X, Maillefert JF, Mariette X, Schaeverbeke T, Tebib J, Combe B: Clinical and laboratory follow-up for treating and monitoring patients with ankylosing spondylitis: development of recommendations for clinical practice based on published evidence and expert opinion. Joint Bone Spine. 2007, 74 (4): 330-337. 10.1016/j.jbspin.2007.04.002.CrossRefPubMed
22.
Salliot C, Dernis E, Lavie F, Cantagrel A, Gaudin P, Wendling D, Claudepierre P, Flipo RM, Goupille PM, Le Loet X, Maillefert JF, Paul C, Saraux A, Schaeverbeke T, Tebib J, Combe B: Diagnosis of peripheral psoriatic arthritis: recommendations for clinical practice based on data from the literature and experts opinion. Joint Bone Spine. 2009, 76 (5): 532-539. 10.1016/j.jbspin.2009.03.004.CrossRefPubMed
23.
Lobach DF, Kerner N: A systematic process for converting text-based guidelines into a linear algorithm for electronic implementation. Proc AMIA Symp. 2000, 507-511.
24.
Dean E: Oxygen transport: a physiologically-based conceptual framework for the practice of cardiopulmonary physiotherapy. Physiotherapy. 1994, 347-355. 80
25.
Ross J, Dean E: Integrating physiological principles into the comprehensive management of cardiopulmonary dysfunction. Phys Ther. 1989, 69 (4): 255-259.PubMed
26.
Browning L, Denehy L, Scholes RL: The quantity of early upright mobilisation performed following upper abdominal surgery is low: An observational study. Australian Journal of Physiotherapy. 2007, 53 (1): 47-52. 10.1016/S0004-9514(07)70061-2.CrossRefPubMed
27.
Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, Ross A, Anderson L, Baker S, Sanchez M, Penley L, Howard A, Dixon L, Leach S, Small R, Hite RD, Haponik E: Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008, 36 (8): 2238-2243. 10.1097/CCM.0b013e318180b90e.CrossRefPubMed
28.
Thomsen GE, Snow GL, Rodriguez L, Hopkins RO: Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med. 2008, 36 (4): 1119-1124. 10.1097/CCM.0b013e318168f986.CrossRefPubMed
29.
Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP: Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009, 373 (9678): 1874-1882. 10.1016/S0140-6736(09)60658-9.CrossRefPubMed
30.
Stiller K, Montarello J, Wallace M, Daff M, Grant R, Jenkins S, Hall B, Yates H: Efficacy of breathing and coughing exercises in the prevention of pulmonary complications after coronary artery surgery. Chest. 1994, 105 (3): 741-747. 10.1378/chest.105.3.741.CrossRefPubMed
31.
Schunemann HJ, Fretheim A, Oxman AD: Improving the use of research evidence in guideline development: 9. Grading evidence and recommendations. Health Res Policy Syst. 2006, 4: 21-10.1186/1478-4505-4-21.CrossRefPubMedPubMedCentral
32.
Bartlett RH, Gazzaniga AB, Geraghty T: The yawn maneuver: prevention and treatment of postoperative pulmonary complications. Surg Forum. 1971, 22: 196-198.PubMed
33.
Garrard CS, Shah M: The effects of expiratory positive airway pressure on functional residual capacity in normal subjects. Crit Care Med. 1978, 6 (5): 320-322. 10.1097/00003246-197809000-00004.CrossRefPubMed
34.
Ricksten SE, Bengtsson A, Soderberg C, Thorden M, Kvist H: Effects of periodic positive airway pressure by mask on postoperative pulmonary function. Chest. 1986, 89 (6): 774-781. 10.1378/chest.89.6.774.CrossRefPubMed
35.
Gosselink R, Schrever K, Cops P, Witvrouwen H, De Leyn P, Troosters T, Lerut A, Deneffe G, Decramer M: Incentive spirometry does not enhance recovery after thoracic surgery. Crit Care Med. 2000, 28 (3): 679-683. 10.1097/00003246-200003000-00013.CrossRefPubMed
36.
Westerdahl E, Lindmark B, Eriksson T, Friberg O, Hedenstierna G, Tenling A: Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery. Chest. 2005, 128 (5): 3482-3488. 10.1378/chest.128.5.3482.CrossRefPubMed
37.
Ferreyra GP, Baussano I, Squadrone V, Richiardi L, Marchiaro G, Del Sorbo L, Mascia L, Merletti F, Ranieri VM: Continuous positive airway pressure for treatment of respiratory complications after abdominal surgery: a systematic review and meta-analysis. Ann Surg. 2008, 247 (4): 617-626. 10.1097/SLA.0b013e3181675829.CrossRefPubMed
38.
Jones M, Grimmer K, Edwards J, Higgs J, Trede F: Challenges in Applying Best EVidence to Physiotherapy Practice: Part 2-Health and Clinical Reasoning Models to Facilitate Evidence-Based Practice. Internet Journal of Allied Health Sciences and Practice. 2006, 4 (4): 1-9.
39.
Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn't. BMJ. 1996, 312 (7023): 71-72. 10.1136/bmj.312.7023.71.CrossRefPubMedPubMedCentral
40.
Elwyn G, O'Connor A, Stacey D, Volk R, Edwards A, Coulter A, Thomson R, Barratt A, Barry M, Bernstein S, Butow P, Clarke A, Entwistle V, Feldman-Stewart D, Holmes-Rovner M, Llewellyn-Thomas H, Moumjid N, Mulley A, Ruland C, Sepucha K, Sykes A, Whelan T, International Patient Decision Aids Standards (IPDAS) Collaboration: Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ. 2006, 333 (7565): 417-10.1136/bmj.38926.629329.AE.CrossRefPubMedPubMedCentral
41.
Graham B, Regehr G, Wright JG: Delphi as a method to establish consensus for diagnostic criteria. J Clin Epidemiol. 2003, 56 (12): 1150-1156. 10.1016/S0895-4356(03)00211-7.CrossRefPubMed
42.
Fretheim A, Schunemann HJ, Oxman AD: Improving the use of research evidence in guideline development: 5. Group processes. Health Res Policy Syst. 2006, 4: 17-10.1186/1478-4505-4-17.CrossRefPubMedPubMedCentral
43.
Keeney S, Hasson F, McKenna H: Consulting the oracle: ten lessons from using the Delphi technique in nursing research. J Adv Nurs. 2006, 53 (2): 205-212. 10.1111/j.1365-2648.2006.03716.x.CrossRefPubMed
44.
Hung HL, Altschuld JW, Lee YF: Methodological and conceptual issues confronting a cross-country Delphi study of educational program evaluation. Eval Program Plann. 2008, 31 (2): 191-198. 10.1016/j.evalprogplan.2008.02.005.CrossRefPubMed
45.
Zlowodzki M, Jonsson A, Bhandari M: Common pitfalls in the conduct of clinical research. Med Princ Pract. 2006, 15 (1): 1-8. 10.1159/000089379.CrossRefPubMed
46.
Lochner HV, Bhandari M, Tornetta P: Type-II error rates (beta errors) of randomized trials in orthopaedic trauma. J Bone Joint Surg Am. 2001, 83-A (11): 1650-1655.PubMed
47.
Dane FC: Type II errors in 'Nurses' prediction of volume status after aneurysmal subarachnoid hemorrhage: a prospective cohort study'. Crit Care. 2009, 13 (1): 402-10.1186/cc7705.CrossRefPubMedPubMedCentral
48.
Lieberman MD, Cunningham WA: Type I and Type II error concerns in fMRI research: re-balancing the scale. Soc Cogn Affect Neurosci. 2009, 4 (4): 423-428. 10.1093/scan/nsp052.CrossRefPubMedPubMedCentral
49.
Bailey CS, Fisher CG, Dvorak MF: Type II error in the spine surgical literature. Spine (Phila Pa 1976). 2004, 29 (10): 1146-1149. 10.1097/00007632-200405150-00018.CrossRef
50.
Moher D, Liberati A: Reporting systematic reviews and meta-analyses: Asking authors, peer reviewers, editors and funders to do better. Med Clin (Barc). 2010
51.
Glasziou PP, Shepperd S, Brassey J: Can we rely on the best trial? A comparison of individual trials and systematic reviews. BMC Med Res Methodol. 2010, 10: 23-10.1186/1471-2288-10-23.CrossRefPubMedPubMedCentral
52.
Grimmer K, Bialocerkowski A, Kumar S, Milanese S: Implementing evidence in clinical practice: the 'therapies' dilemma. Physiotherapy. 2004, 90 (4): 189-194. 10.1016/j.physio.2004.06.007.CrossRef
53.
Treweek S, Zwarenstein M: Making trials matter: pragmatic and explanatory trials and the problem of applicability. Trials. 2009, 10: 37-10.1186/1745-6215-10-37.CrossRefPubMedPubMedCentral
Metadata
Title
Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence
Authors
Susan D Hanekom
Dina Brooks
Linda Denehy
Monika Fagevik-Olsén
Timothy C Hardcastle
Shamila Manie
Quinette Louw
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2012
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/1472-6947-12-5

Other articles of this Issue 1/2012

BMC Medical Informatics and Decision Making 1/2012 Go to the issue

Software

The R0 package: a toolbox to estimate reproduction numbers for epidemic outbreaks

Research article

A multiscale and multiparametric approach for modeling the progression of oral cancer

Research article

Intention to adopt clinical decision support systems in a developing country: effect of Physician’s perceived professional autonomy, involvement and belief: a cross-sectional study

Research article

Predicting sample size required for classification performance

Research article

CMDX©-based single source information system for simplified quality management and clinical research in prostate cancer

Research article

Comparing virtual consults to traditional consults using an electronic health record: an observational case–control study