title: Efficacy of breathing and coughing exercises in the prevention of pulmonary complications after coronary artery surgery. Incidence of and risk factors for pulmonary complications after nonthoracic surgery. Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). Pre-operative short-term pulmonary rehabilitation for patients of chronic obstructive pulmonary disease undergoing coronary artery bypass graft surgery. Aerobic interval training versus continuous moderate exercise after coronary artery bypass surgery: a randomized study of cardiovascular effects and quality of life. Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer. Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement. Pre-Arthroplasty Rehabilitation is Effective in Reducing Hospital Stay Preoperative evaluation of cardiopulmonary reserve with the use of expired gas analysis during exercise testing in patients with squamous cell carcinoma of the thoracic esophagus. The effect of preoperative physiotherapy and education on the outcome of total hip replacement: a prospective randomized controlled trial The effect of a preoperative exercise and education program on functional recovery, health related quality of life, and health service utilization following primary total knee arthroplasty. Responsive measures to prehabilitation in patients undergoing bowel resection surgery. Effect of a video intervention on functional recovery following hip replacement and hip fracture repair. The effects of short-term preoperative physical therapy and education on early functional recovery of patients younger than 70 undergoing total hip arthroplasty. Costs and quality of life for prehabilitation and early rehabilitation after surgery of the lumbar spine Feasibility of preoperative inspiratory muscle training in patients undergoing coronary artery bypass surgery with a high risk of postoperative pulmonary complications: a randomized controlled pilot study Preoperative Exercise Vo2 Measurement for Lung Resection Candidates: Results of Cancer and Leukemia Group B Protocol 9238 Excess mortality following hip fracture: the role of underlying health status Perioperative Exercise Programs Improve Early Return of Ambulatory Function After Total Hip Arthroplasty: A Randomized, Controlled Trial Prevention of pulmonary complications after upper abdominal surgery by preoperative intensive inspiratory muscle training: a randomized controlled pilot study Preoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery. Randomized controlled trial of prophylactic chest physiotherapy in major abdominal surgery Effect of pre-operative physiotherapy in patients with end-stage osteoarthritis undergoing hip arthroplasty Pre- and Postoperative Cardiopulmonary Rehabilitation in Hospitalized Patients Undergoing Coronary Artery Bypass Surgery: A Randomized Controlled Trial [Fewer lung complications following inspiratory muscle training in patients undergoing coronary bypass surgery: a randomized trial]. Reliability of the PEDro scale for rating quality of randomized controlled trials. Effect of preoperative physiotherapy in unicompartmental prosthetic knee replacement. Preoperative maximal exercise oxygen consumption test predicts postoperative pulmonary morbidity following major lung resection. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Exercise Improves Early Functional Recovery After Total Hip Arthroplasty The Effect of Preoperative Exercise on Total Knee Replacement Outcomes Influence of preoperative patient education on the risk of dislocation after primary total hip arthroplasty. Prophylactic Inspiratory Muscle Training in Patients Undergoing Coronary Artery Bypass Graft The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty.
abstract: One hundred twenty patients undergoing coronary artery surgery completed a r and omized controlled study design ed to investigate whether prophylactic chest physiotherapy affected the incidence of postoperative pulmonary complications . Group 1 patients received no preoperative or postoperative chest physiotherapy . Group 2 patients received preoperative education and instruction in breathing and coughing exercises and postoperative supervision and assistance in performing the same . These exercises were supervised by a physiotherapist twice per day on the first 2 postoperative days and once per day on the 3rd and 4th postoperative days . Physiotherapy for group 3 patients was the same as for group 2 patients except that patients were seen by a physiotherapist 4 times per day on the first 2 postoperative days and twice per day on the 3rd and 4th postoperative days . Group 2 and 3 patients were instructed to practice breathing and coughing exercises every hour . Overall , an incidence of clinical ly significant postoperative pulmonary complications of 7.5 percent was demonstrated . In general , these patients demonstrated lower levels of preoperative pulmonary function and very low early postoperative oxygenation compared with those who did not develop pulmonary complications . There was no indication that the incidence or severity of fever , hypoxemia , chest roentgenologic abnormalities or clinical ly significant postoperative pulmonary complications was different between groups . These results suggest that the necessity for prophylactic chest physiotherapy after routine coronary artery surgery should be review ed The prediction of postoperative pulmonary complications is an underinvestigated field . We conducted a prospect i ve cohort study ( with postoperative pulmonary complications ascertained by an investigator blinded to perioperative variables ) to determine the risk factors for pulmonary complications after elective nonthoracic surgery . Of 1,055 consecutive patients attending the Pre-Admission Clinic of a university hospital ( mean age 55 years , 50 % men , 15 % with history of obstructive airways disease ) , 28 ( 2.7 % ) suffered a postoperative pulmonary complication within 7 days of surgery : 13 patients developed respiratory failure requiring ventilatory support , 9 pneumonia , 5 atelectasis requiring bronchoscopic intervention , and 1 pneumothorax requiring intervention . Mean lengths of stay were substantially prolonged for those patients who developed pulmonary complications within 7 days of surgery : 27.9 days versus 4.5 days , p = 0.006 . Eight variables were statistically significantly associated with pulmonary complications on bivariate analyses . Multivariate analyses revealed that four were independently associated with increased risk of pulmonary complications : age ( odds ratio [ OR ] 5.9 for age > /= 65 years , p < 0.001 ) , positive cough test ( OR 3.8 , P = 0.01 ) , perioperative nasogastric tube ( OR 7.7 , p < 0.001 ) , and duration of anesthesia ( OR 3.3 for operations lasting at least 2.5 hours , p = 0.008 ) . Thus , several perioperative factors predict an increased risk for pulmonary complications after elective nonthoracic surgery Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials The role of pre-operative short-term pulmonary rehabilitation in patients with chronic obstructive pulmonary disease who undergo coronary artery bypass graft surgery has been assessed for the first time prospect ively . Forty-five patients posted for coronary artery bypass graft surgery  were r and omised to receive either short-term pulmonary rehabilitation ( group I ) or no such programme ( group II ) . Patients of both the groups were evenly matched with respect to age , sex , body surface area , duration and severity of chronic obstructive pulmonary disease and coronary artery disease . Normal individuals who evenly matched with the study group were assessed for normal respiratory function parameters . Pre-operative and post-operative peak expiratory flow rate , inspiratory capacity , post-operative ventilation time , post-operative pulmonary complication and hospital stay were determined in both the groups . Peak expiratory flow rate ( 220.0 + /- 12.9 and 324.3 + /- 84.3 in group I , 218.0 + /- 16.4 and 260.5 + /- 35.2 in group II ) and inspiratory capacity ( 844.0 + /- 147.4 and 1100.0 + /- 158.1 in group I , 830.0 + /- 117.4 and 1090 + /- 137 in group II ) were significantly lower before and after surgery respectively in both groups compared to normal values . Even though both groups showed a significant rise in post-operative peak expiratory flow rate and inspiratory capacity after surgery , the post-operative peak expiratory flow rate and inspiratory capacity in group I was significantly higher than in group II . In group I , the post-operative ventilation time ( 24.5 + /- 6.00 hours ) , post-operative complications ( n = 4 ) and hospital stay ( 12.4 + /- 3.6 days ) were significantly lower than in group II ( 35.2 + /- 22.3 hours , n = 11 , 18.8 + /- 6.6 days respectively ) . These data suggest that short-term pulmonary rehabilitation is feasible and effective in improving pulmonary functions before and after surgery and in reducing surgical morbidity and cost of medical care significantly BACKGROUND Peak oxygen uptake ( Vo(2peak ) ) strongly predicts mortality in cardiac patients . We compared the effects of aerobic interval training ( AIT ) versus moderate continuous training ( MCT ) on Vo(2peak ) and quality of life after  coronary artery bypass grafting ( CABG ) . METHODS Fifty-nine CABG patients were r and omized to either AIT at 90 % of maximum heart rate or MCT at 70 % of maximum heart rate , 5 d/wk , for 4 weeks at a rehabilitation center . Primary outcome was Vo(2peak ) , at baseline , after rehabilitation ( 4 weeks ) , and after 6 months of home-based exercise ( 6 months ) . RESULTS Vo(2peak ) increased between baseline and 4 weeks in AIT ( 27.1 + /- 4.5 vs 30.4 + /- 5.5 mL.kg(-1).min(-1 ) , P < .001 ) and MCT ( 26.2 + /- 5.2 vs 28.5 + /- 5.6 mL.kg(-1).min(-1 ) , P < .001 ; group difference , not significant ) . Aerobic interval training increased Vo(2peak ) between 4 weeks and 6 months ( 30.4 + /- 5.5 vs 32.2 + /- 7.0 mL.kg(-1).min(-1 ) , P < .001 ) , with no significant change in MCT ( 28.5 + /- 5.6 vs 29.5 + /- 5.7 mL.kg(-1).min(-1 ) ) . Quality of life improved in both groups from baseline to 4 weeks , remaining improved at 6 months . There were no changes in echocardiographic systolic and diastolic left ventricular function . Adiponectin increased between 4 weeks and 6 months in both groups ( group differences , not significant ) . CONCLUSIONS Four weeks of intense training increased Vo(2peak ) significantly after both AIT and MCT . Six months later , the AIT group had a significantly higher Vo(2peak ) than MCT . The results indicate that AIT and MCT increase Vo(2peak ) similarly in the short term , but with better long-term effect of AIT after CABG BACKGROUND The impact of short-term preoperative pulmonary rehabilitation on exercise capacity of patients with chronic obstructive pulmonary disease undergoing lobectomy for non-small cell lung cancer is evaluated . METHODS A prospect i ve observational study was design ed . Inclusion criteria consisted of an indication to lung resection because of a clinical stage I or II non-small cell lung cancer and a chronic obstructive disease on preoperative pulmonary function test . In such conditions , maximal oxygen consumption by a cardio-pulmonary exercise test was evaluated ; when this result ed as being < or = 15 ml/kg/min a pulmonary rehabilitation programme lasting 4 weeks was considered . Twelve patients fulfilled inclusion criteria , completed the preoperative rehabilitation programme and underwent a new functional evaluation prior to surgery . The postoperative record of these patients was collected . RESULTS On completion of pulmonary rehabilitation , the resting pulmonary function test and diffuse lung capacity of patients was unchanged , whereas the exercise performance was found to have significantly improved ; the mean increase in maximal oxygen consumption proved to be at 2.8 ml/kg/min ( p<0.01 ) . Eleven patients underwent lobectomy ; no postoperative mortality was noted and mean hospital stay was 17 days . Postoperative pulmonary complication was recorded in 8 patients . CONCLUSIONS Short-term preoperative pulmonary rehabilitation could improve the exercise capacity of patients with chronic obstructive pulmonary disease who are c and i date s for lung resection for non-small cell lung cancer OBJECTIVE To evaluate the effects of st and ardized western acupuncture and physiotherapy on pain and functional ability in patients with severe osteoarthritic knee pain awaiting knee arthroplasty . METHODS Three-arm , assessor-blind , r and omized controlled trial . PARTICIPANTS 181 patients awaiting knee arthroplasty . INTERVENTIONS acupuncture for 6 weeks ; physiotherapy for 6 weeks ; st and ardized advice . MAIN OUTCOME MEASURES Oxford Knee Score question naire ( OKS ) ( primary ) ; 50 m timed walk , and duration of hospital stay following knee arthroplasty . RESULTS There was no baseline difference between groups . At 7 weeks , there was a 10 % reduction in OKS in the acupuncture group which was a significant difference between the acupuncture and the control group : Mean ( s.d . ) acupuncture 36.8 ( 7.20 ) ; physiotherapy 39.2 ( 8.22 ) ; control 40.3 ( 8.48 ) ( P = 0.0497 ) . These effects were no longer present at 12 weeks . There was a trend ( P = 0.0984 ) towards a shorter in-patient stay of 1 day for the physiotherapy group [ mean 6.50 days ( s.d . 2.0 ) ] compared with the acupuncture group [ mean 7.77 days ( s.d . 3.96 ) ] . CONCLUSIONS We have demonstrated that patients with severe knee osteoarthritis can achieve a short-term reduction in OKS when treated with acupuncture . However , we failed to demonstrate any other clinical ly or statically significant effects between the groups . Both interventions can be delivered effectively in an out-patient group setting at a district general hospital . Further study is needed to evaluate the combined effects of these treatments Backround . The purpose of the trial was to evaluate the effect on length of stay of individually tailored rehabilitation for clients who were undergoing hip or knee arthroplasty . Method . Clients ( n = 133 ) with complex needs ( comorbid conditions or limited social support ) were r and omly assigned to receive  preoperative usual care ( UC ) or rehabilitation ( R ) . Usual care clients received a single preoperative clinic visit . Rehabilitation clients were individually assessed and received multi disciplinary rehabilitation to optimize functional capacity , education about the in-hospital phase and early discharge planning . All rehabilitation subjects received interdisciplinary counseling/education focused on preparation for discharge home  . The intervention for approximately half the rehabilitation clients was a single ,  cost-effective session , while others received physical conditioning . Results . Clients receiving rehabilitation achieved discharge criteria earlier ( R = 5.4 , UC = 8 days ) and had a shorter actual length of stay ( R = 6.5 , UC = 10.5 days ) . Clinical Implication s. This preoperative , individually tailored , rehabilitation program reduced length of stay OBJECTIVE We evaluated the usefulness of analyzing expired gas during exercise testing for the prediction of postoperative cardiopulmonary complications in patients with esophageal carcinoma . BACKGROUND DATA Radical esophagectomy with 3-field lymphadenectomy is performed in patients with thoracic esophageal carcinoma but has a high risk of postoperative complications . To reduce the surgical risk , we performed preoperative risk analysis using 8 factors . Although hospital mortality was decreased when this risk analysis was used , severe cardiopulmonary complications still occurred . METHODS The study group consisted of 91 patients who had undergone curative esophagectomy with 3-field lymphadenectomy .  The maximum oxygen uptake , anaerobic threshold , vital capacity , percent vital capacity , forced expiratory volume in 1 second , percent forced expiratory volume , V.(25)/HT , forced expired flow at 75 % of forced vital capacity to height ratio ( FEF(75%)/HT ) , forced expired flow at 50 % to 75 % of forced vital capacity ratio ( FEF(50%)/FEF(75 % ) ) , percent diffusion capacity for carbon monoxide , and arterial oxygen tension were measured . Patients were divided into 2 groups on the basis of the presence or absence of postoperative cardiopulmonary complications . RESULTS Only the maximum oxygen uptake was significantly different between the 2 groups . All patients were grouped according to the value of the maximum oxygen uptake , and the occurrence of postoperative cardiopulmonary complications was calculated for each group . A cardiopulmonary complication rate of 86 % was found for patients with a maximum oxygen uptake of less than 699 mL. min(-1 ) . m(-2 ) ; for those with a value of 700 to 799 mL. min(-1 ) . m(-2 ) , the complication rate was 44 % . CONCLUSIONS The maximum oxygen uptake obtained by expired gas analysis during exercise testing correlates with the postoperative cardiopulmonary complication rate . On the basis of these results , esophagectomy with 3-field lymphadenectomy can be safely performed in patients with a maximum oxygen uptake of at least 800 mL. min(-1 ) . m(-2 ) Objective : To investigate the effects of preoperative physical therapy for patients undergoing total hip replacement . Design : Prospect i ve r and omized controlled study . Setting : Department of Orthopaedics and Traumatology in a university hospital . Subjects : Sixty patients with osteoarthritis of the hip scheduled to receive total hip replacement were r and omly assigned into two groups . Interventions : Subjects in the study group received preoperative physiotherapy design ed to strengthen the muscles of the upper and lower limbs and to improve range of motion of the hip , beginning from eight weeks before the operation . These patients also received an educational programme about living with a prosthesis . The control group received no preoperative physiotherapy or educational programme . Main outcome measures : Patients were evaluated at baseline ( study group only , eight weeks prior to operation ) , before surgery , at discharge , three months and two years postoperatively using Harris Hip Score , visual analogue scale and range at hip abduction . Results : Although patients in the study group performed transfer activities earlier than the control group , there were no significant differences between the groups at discharge with regard to the improvement in Harris Hip Score ( p < 0.48 ) and hip adduction ( p < 0.97 ) and visual analogue scale at rest ( p < 0.54 ) and activity ( p < 0.89 ) . At the latest follow-up ( two years postoperatively ) both groups had improved in Harris Hip Score , but rate of improvement between the groups was similar ( p < 0.05 ) . Conclusions : We conclude that the routine use of preoperative physiotherapy and education programme is not useful in total hip replacement surgery OBJECTIVE To determine the effectiveness of a preoperative exercise/education program on functional recovery , health related quality of life ( HRQOL ) , health service utilization , and costs following primary total knee arthroplasty ( TKA ) . METHODS One hundred thirty-one subjects were r and omized to either the  control ( n = 66 ) or treatment ( n = 65 ) group 6 weeks before TKA surgery . Patients in the treatment group underwent a 4-week exercise/education program before surgery . All subjects were assessed 6 weeks preoperatively ( before the exercise/education intervention ) , immediately preoperatively ( after the exercise/education intervention ) , and 3 , 6 and 12 months after surgery utilizing the Western Ontario McMaster Osteoarthritis Index , the SF-36 , and knee range of motion ( ROM ) and strength measures . Data on length of stay , numbers of community rehabilitation or homecare visits following discharge from the surgical hospital , and the costs associated with these services were also collected . RESULTS Subjects were similar in demographic characteristics and all measurements at the baseline assessment . No differences were seen in knee measurements ( ROM and strength ) , pain , function , or HRQOL between the 2 groups following the intervention program or at any postoperative measurement point . Patients in the treatment group used fewer postoperative rehabilitation services and stayed for a shorter time in hospital than the control group , but these differences did not attain statistical significance . CONCLUSION The exercise/education intervention did not alter functional recovery or HRQOL following TKA . Health service utilization was less in the treatment group , but our study was underpowered to attain statistical significance for these measures Surgical patients often show physiological and metabolic distress , muscle weakness , and long hospital stays . Physical conditioning might help recovery . We attempted to identify the most responsive measure of aerobic fitness from a four-week pre-surgical aerobic exercise program ( prehabilitation ) in patients undergoing major bowel resection . Twenty-one subjects r and omized two to one ( exercise : control ) scheduled for colorectal surgery . Fourteen subjects [ Body Mass Index ( BMI ) = 27 + /- 6 kg/m(2 ) ; maximal oxygen uptake ( VO(2max ) ) = 22 + /- 10 ml/kg/min ] underwent 3.8 + /- 1.2 weeks ( 27 + /- 8 sessions ) of progressive , structured pre-surgical aerobic exercise training at 40 to 65 % of heart rate reserve ( % HRR ) . Peak power output was the only maximal measure that was responsive to training [ 26 + /- 27 % , Effects Size ( ES ) = 0.24 ; St and ardized Response Mean ( SRM ) = 1.05 ; p < 0.05 ] . For the submaximal measures , heart rate and oxygen uptake during submaximal exercise was most responsive to training ( decrease by 13 % + /- 15 % , ES = -0.24 ; SRM = -0.57 ; and 7 % + /- 6 % , ES = -0.40 ; SRM -0.97 ; p < 0.05 ) at an exercise intensity of 76 + /- 47 W. There was no change to maximal or submaximal measures in the control group . The distance walked over six minutes improved in both groups ( by approximately 30 m ) , but the effect size and t-statistic were higher in the exercise group . Heart rate and oxygen uptake during submaximal exercise , and peak power output are the most responsive measures to four weeks of prehabilitation in subjects with low initial fitness Although much research has documented the functional outcomes in hip repair surgery , few studies have identified effective interventions to improve functional outcomes . The purpose of this study was to test the use of generic and individualized videos on patients ' return to preoperative levels of independent functioning , increased physical performance , improved coping ability , and enhanced perception of ability to care for self .  Two rehabilitation units in separate acute care facilities were used to recruit subjects . Data were collected on 82 participants on admission to the study , on discharge from rehabilitation , 1 week after discharge , and 3 months post discharge . The results indicate that video intervention has some benefit to persons recovering from hip repair surgery . The benefits were realized in physical performance as evidence d by a significant difference in the distance walked and time walked of participants in the treatment group BACKGROUND / AIM Hip arthroplasty is a routine operation which relieves pain in patients with osteoarthritis . The role of physical therapy after hip arthroplasty was recognized , but the importance of preoperative physical therapy and education is still to be judged . The aim of this paper was to investigate the effect of short-term preoperative program of education and physical therapy on patients ' early functional recovery immediately after total hip arthroplasty ( THA ) . METHODS This prospect i ve study included 45 patients with hip osteoarthritis scheduled to undergo primary THA and admitted to the Department of Orthopedics of Military Medical Academy . They were r and omized into 2 groups : study and control one ( with and without preoperative education and physical therapy ) . Preoperative education was conducted through conversation ( 1 appointment with physiatrist ) and brochure . The study group was instructed to perform exercises and basic activities from the postoperative rehabilitation program ( 2 practical classes with physiotherapist ) . Effects were measured with question naires ( Harris , Oxford and Japanese Orthopaedic Association ( JOA ) hip scores ) , range of motion and visual analog scale of pain . Marks showing ability to perform basic activities and endurance were from 0 ( did not perform activity ) to 5 ( independent and secure ) . Analyses examined differences between the groups over the preoperative and immediate postoperative periods and 15 months after the operation . RESULTS There were no differences between the groups at discharge according to pain , range of motion , Harris hip score and JOA hip score . Oxford hip score did not differ between the groups 15 months after the operation . The groups started to walk at the same time , but the study group walked up and down stairs ( 3.7+/-1.66 vs 5.37+/-1.46 , p < or = 0.002 ) , used toilet ( 2.3+/-0.92 vs 3.2+/-1.24 , p < or = 0.02 ) and chair ( 2.2+/-1.01 vs 3.25+/-1.21 , p < or = 0.006 ) significantly earlier than the control group . On the third day after the operation the study group was significantly more independent than the control one while performing any basic activities ( changing position in bed from supine to side lying , from supine to sitting on the edge of the bed , from sitting to st and ing , from st and ing to lying in the bad , st and ing , walking , using toilet and chair ) . At discharge the patients from the control group still needed the therapist help for walking up and down stairs ( 3+/-1.26 ) , while the patients from the study group performed there activities independently ( 4.85+/-0.37 ) ( p < or = 0.000 ) . Endurance while walking was significantly better in the study group than in the control one . The length of hospital stay after the operation was similar for both groups , but the patients from the study group needed significantly less classes with the therapist ( 5.2+/-2.35 vs 6.85+/-1.14 , p < or = 0.02 ) during hospital stay . CONCLUSION The short-term preoperative program of education with the elements of physical therapy accelerated early functional recovery of patients ( younger than 70 ) immediately after THA and we recommend it for routine use Abstract During the recent years improved operation techniques and administrative procedures have been developed for early rehabilitation . At the same time preoperative lifestyle intervention ( prehabilitation ) has revealed a large potential for additional risk reduction . The aim was to assess the quality of life and to estimate the cost-effectiveness of st and ard care versus an integrated programme including prehabilitation and early rehabilitation . Methods The analyses were based on the results from 60 patients undergoing lumbar fusion for degenerative lumbar disease ; 28 patients were r and omised to the integrated programme and 32 to the st and ard care programme .  Data on cost and health related quality of life was collected preoperatively , during hospitalisation and postoperatively . The cost was estimated from multiplication of the re source consumption and price per unit . Results Overall there was no difference in health related quality of life scores . The patients from the integrated programme obtained their postoperative milestones sooner , returned to work and soaked less primary care after discharge . The integrated programme was 1,625 € ( direct costs 494 € + indirect costs 1,131 € ) less costly per patient compared to the st and ard care programme . Conclusion The integrated programme of prehabilitation and early rehabilitation in spine surgery is more cost-effective compared to st and ard care programme alone Objective : To determine in a pilot study the feasibility and effects of preoperative inspiratory muscle training in patients at high risk of postoperative pulmonary complications who were scheduled for coronary artery bypass graft surgery . Design : Single-blind , r and omized controlled pilot study . Setting : University Medical Centre Utrecht , the Netherl and s. Subjects : Twenty-six patients at high risk of postoperative pulmonary complications were selected . Intervention : The intervention group ( N = 14 ) received 2 - 4 weeks of preoperative inspiratory muscle training on top of the usual care received by the patients in the control group . Main measures : Primary outcome variables of feasibility were the occurrence of adverse events , and patient satisfaction and motivation . Secondary outcome variables were postoperative pulmonary complications and length of hospital stay . Results : The feasibility of inspiratory muscle training was good and no adverse events were observed . Treatment satisfaction and motivation , scored on 10-point scales , were 7.9 ( ± 0.7 ) and 8.2 ( ± 1.0 ) , respectively . Postoperative atelectasis occurred in significantly fewer patients in the intervention group than in the control group ( ϰ2 DF1 = 3.85 ; P = 0.05 ) : Length of hospital stay was 7.93 ( ± 1.94 ) days in the intervention group and 9.92 ( ± 5.78 ) days in the control group ( P = 0.24 ) . Conclusion : Inspiratory muscle training for 2 - 4 weeks before coronary artery bypass graft surgery was well tolerated by patients at risk of postoperative pulmonary complications and prevented the occurrence of atelectasis in these patients . A larger r and omized clinical trial is warranted Introduction : A stepwise approach to the functional assessment of lung resection c and i date s is widely accepted , and this approach incorporates the measurement of exercise peak Vo2 when spirometry and radionuclear studies suggest medical inoperability . A new functional operability ( FO ) algorithm incorporates peak exercise Vo2 earlier in the preoperative assessment to determine which patients require preoperative radionuclear studies . This algorithm has not been studied in a multicenter study . Methods : The CALGB ( Cancer and Leukemia Group B ) performed a prospect i ve multi-institutional study to investigate the use of primary exercise Vo2 measurement for the prediction of surgical risk . Patients with known or suspected resectable non-small cell lung cancer ( NSCLC ) were eligible .  Exercise testing including measurement of peak oxygen uptake ( Vo2 ) , spirometry , and single breath diffusion capacity ( DLCO ) was performed on each patient . Nuclear perfusion scans were obtained on selected high-risk patients . After surgery , morbidity and mortality data were collected and correlated with preoperative data . Mortality and morbidity were retrospectively compared by algorithm-based risk groups . Results : Three hundred forty-six patients with suspected lung cancer from nine institutions underwent thoracotomy with or without resection ; 57 study patients did not undergo thoracotomy .  Patients who underwent surgery had a median survival time of 30.9 months , whereas patients who did not undergo surgery had a median survival time of 15.6 months . Among the 346 patients who underwent thoracotomy , 15 patients died postoperatively ( 4 % ) , and 138 patients ( 39 % ) exhibited at least one cardiorespiratory complication postoperatively . We found that patients who had a peak exercise Vo2 of < 65 % of predicted ( or a peak Vo2/kg < 16 ml/min/kg ) were more likely to suffer complications ( p = 0.0001 ) and were also more likely to have a poor outcome ( respiratory failure or death ) if the peak Vo2 was < 15 ml/min/kg ( p = 0.0356 ) . We also found a subset of 58 patients who did not meet FO algorithm criteria for operability , but who still tolerated lung resection with a 2 % mortality rate . Conclusions : Our data provide multicenter validation for the use of exercise Vo2 for preoperative assessment of lung cancer patients , and we encourage an aggressive approach when evaluating these patients for surgery Summary We evaluated the long-term excess mortality associated with hip fracture , using prospect ively collected data on pre-fracture health and function from a nationally representative sample of U.S. elders . Although mortality was elevated for the first six months following hip fracture , we found no evidence of long-term excess mortality . Introduction The long-term excess mortality associated with hip fracture remains controversial . Methods To assess the association between hip fracture and mortality , we used prospect ively collected data on pre-fracture health and function from a representative sample of U.S. elders in the Medicare Current Beneficiary Survey ( MCBS ) to perform survival analyses with time-varying covariates . Results Among 25,178 MCBS participants followed for a median duration of 3.8 years , 730 sustained a hip fracture during follow-up . Both early ( within 6 months ) and subsequent mortality showed significant elevations in models adjusted only for age , sex and race . With additional adjustment for pre-fracture health status , functional impairments , comorbid conditions and socioeconomic status , however , increased mortality was limited to the first six months after fracture ( hazard ratio [ HR ] : 6.28 , 95 % CI : 4.82 , 8.19 ) . No increased mortality was evident during subsequent follow-up ( HR : 1.04 , 95 % CI : 0.88 , 1.23 ) . Hip-fracture-attributable population mortality ranged from 0.5 % at age 65 among men to 6 % at age 85 among women . Conclusions Hip fracture was associated with substantially increased mortality , but much of the short-term risk and all of the long-term risk was explained by the greater frailty of those experiencing hip fracture Wang AW , Gilbey HJ , Ackl and TR : Perioperative exercise programs improve early return of ambulatory function after total hip arthroplasty : A r and omized , controlled trial . Am J Phys Med Rehabil 2002;81:801–806 . Objective Patients with endstage hip arthritis have poor ambulatory function . The aim of this study was to determine if perioperative exercise programs are well tolerated by these elderly patients and if a customized program can achieve an earlier recovery of normal ambulatory function after total hip arthroplasty . Design Twenty-eight subjects scheduled for total hip arthroplasty were r and omized to either the exercise group and received a perioperative customized exercise program or the control group and received the routine perioperative care .  Ambulatory function was assessed by measurement of gait parameters during a 25-m walk test , and walking endurance was assessed by a 6-min walk test . Results Exercise group subjects attended 97.3 % of scheduled exercise sessions with no training injuries . Exercise group subjects demonstrated greater stride length and gait velocity at 3 wk postsurgery . At 12 and 24 wk postsurgery , gait velocity was greater , and the 6-min walking distance was significantly greater than the control group . Conclusion The study indicates that perioperative customized exercise program are well tolerated in the elderly patient with endstage hip arthritis and are effective in improving the rate of recovery in ambulatory function in the first 6 mo after total hip arthroplasty Objective : To investigate the feasibility and effects of preoperative inspiratory muscle training on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective abdominal aortic aneurysm surgery . Design : Single-blind r and omized controlled pilot study . Setting : Gelderse Vallei Hospital Ede , the Netherl and s. Subjects : Twenty high-risk patients undergoing elective abdominal aortic aneurysm surgery were r and omly assigned to receive preoperative inspiratory muscle training or usual care . Main measures : Effectiveness outcome variables were atelectasis , inspiratory muscle strength and vital capacity , and feasibility outcome variables were adverse effects and patient satisfaction with inspiratory muscle training . Results : Despite r and omization , patients in the intervention group were significantly older than the patients in the control group ( 70 ± 6 years versus 59 ± 6 years , respectively ; P = 0.001 ) . Eight patients in the control group and three in the intervention group developed atelectasis ( P = 0.07 ) . The median duration of atelectasis was 0 days in the intervention group and 1.5 days in the control group ( P = 0.07 ) . No adverse effects of preoperative inspiratory muscle training were observed and patients considered that inspiratory muscle training was a good preparation for surgery . Mean postoperative inspiratory pressure was 10 % higher in the intervention group . Conclusion : Preoperative inspiratory muscle training is well tolerated and appreciated and seems to reduce the incidence of atelectasis in patients scheduled for elective abdominal aortic aneurysm surgery OBJECTIVE To evaluate the occurrence and risk of pulmonary complications in children who underwent pre- and postoperative physiotherapeutic intervention in cardiac surgeries , as well as to compare these patients to those who underwent only postoperative physiotherapeutic intervention . METHODS A r and omized controlled trial was performed with 135 patients from 6 years of age and younger with congenital heart disease who had undergone cardiac surgery . Patients were r and omly assigned to the intervention group ( G1 ) in which they underwent pre- and postoperative physiotherapy or to the control group ( G2 ) in which they underwent only postoperative physiotherapy . Mann-Whitney and the Chi-square tests were used to compare the variables between the groups . The magnitude of the absolute risk was calculated by the number of patients needed to treat . Statistical significance was set at 5 % ( P<0.05 ) . RESULTS 17 patients ( 25 % ) in G1 , and 29 patients ( 43.3 % ) in G2 presented pulmonary complications ( P= 0.025 ) , pneumonia was the most frequent complication , and among the 17 patients in G1 , seven ( 10.3 % ) developed pneumonia , six ( 8.8 % ) developed atelectasis , and four ( 5.9 % ) presented complications due to both complications . In G2 , 13 patients ( 19.4 % ) developed pneumonia , eight ( 11.9 % ) developed atelectasis , and eight ( 11.9 % ) developed pneumonia associated with atelectasis . Absolute risk reduction for the primary outcome was of 18.3 % and the number of needed to treat was 5.5 . CONCLUSION Preoperative respiratory physiotherapy significantly reduced the risk of pulmonary complications in postoperative pediatric cardiac surgery Introduction This r and omized controlled study evaluated the clinical benefit and physiological effects of prophylactic chest physiotherapy in open major abdominal surgery Objective : To examine the effect of pre-operative physiotherapy before hip arthroplasty in patients with end-stage hip osteoarthritis . Design : A prospect i ve r and omized controlled study . Setting : Physical medicine and rehabilitation and orthopaedic departments of Policlinico Gemelli of Rome . Subjects : Twenty-three patients r and omized in study and control groups . Intervention : The study group took part in an educational and physiotherapy programme one month before surgery . Both groups took part in the same inpatient rehabilitation programme after surgery . Main outcome measures : Both groups were evaluated one month ( T0 ) and the day before arthroplasty ( T1 ) , after 15 days ( T2 ) , four weeks ( T3 ) and three months ( T4 ) post surgery , using the Barthel Index , the Short Form-36 ( SF-36 ) , the Western Ontario and McMaster Osteoarthritis Index ( WOMAC ) , the Hip Harris Score ( HHS ) , visual analogue scale ( VAS ) , the British Medical Research Council ( BMRC ) measures of hip abductor and quadriceps strength and range of hip abduction and external rotation . Results : There were no significant differences between groups with regard to the Barthel Index , SF-36 , WOMAC and HHS at T4 . The study group presented significant improvements of the SF-36 physical composite score at T1 . The hip external rotation was significantly higher in the study group at each evaluation and the visual analogue scale values were lower at T1 , T3 and T4 . Conclusion : Pre-operative physiotherapy in patients undergoing hip arthroplasty does not improve impairment and health-related quality of life after intervention . Physiotherapy and educational therapy may be useful for end-stage osteoarthritis Herdy AH , Marcchi PLB , Vila A , Tavares C , Collaço J , Niebauer J , Ribeiro JP : Pre- and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery : a r and omized controlled trial . Am J Phys Med Rehabil 2008;87:714–719 . Objective : Patients who have to wait in the hospital for coronary artery bypass surgery ( CABG ) are exposed to the potential risks of immobilization . This clinical trial was conducted to evaluate the effects of an in-hospital cardiopulmonary rehabilitation program performed before and after CABG on postoperative outcomes . Design : Fifty-six patients who had to wait for CABG in-hospital were r and omly assigned to a cardiopulmonary rehabilitation ( Rehab ; n = 29 ) or to usual care ( Control ; n = 27 ) . In the Rehab group , intervention lasted for at least 5 days preoperatively until discharge . The program consisted of phase I cardiac rehabilitation associated with respiratory physical therapy . Outcomes were blindly evaluated . Results : By hospital discharge , Rehab patients presented a shorter time to endotracheal extubation ( 1054 ± 376 vs. 1340 ± 666 min , P = 0.05 ) , a reduction in the incidence of pleural effusion ( relative risk [ RR ] = 0.2 ; 95 % confidence interval [ CI ] : 0.5–0.8 ) , atelectasis ( RR = 0.15 ; 95 % CI : 0.03–0.8 ) , pneumonia ( 0 vs. 7 cases , [ P = 0.004 ] ) , and atrial fibrillation or flutter ( RR = 0.2 ; 95 % CI : 0.05–0.8 ) . Length of in-hospital stay after surgery was also reduced in the Rehab group ( 5.9 ± 1.1 vs. 10.3 ± 4.6 days [ P < 0.001 ] ) . Conclusion : Pre- and postoperative cardiopulmonary rehabilitation in patients who await CABG in the hospital is superior to st and ard care and leads to a reduced rate of postoperative complications and shorter hospital stay OBJECTIVE The aim of this study was to evaluate the prophylactic efficacy of preoperative physiotherapy , including inspiratory muscle training ( IMT ) , on the incidence of postoperative pulmonary complications ( PPCs ) in high-risk patients scheduled for elective coronary artery bypass grafting ( CABG ) . DESIGN R and omized controlled clinical trial ( www.controlled-trials . com/is rct n17691887 ) . METHOD Of 655 patients referred to a university medical centre in The Netherl and s for elective CABG , 299 met the criteria for being at high risk of developing PPCs . A total of 279 were enrolled and monitored up to discharge from hospital . Patients were r and omly assigned to receive either preoperative IMT ( n=140 ) or usual care ( n=139 ) . Both groups received the same postoperative treatment . RESULTS Both groups were comparable at baseline . Before CABG , 2 control group patients and 1 IMT group patient died . After CABG surgery , PPCs were present in 25 ( 18 % ) of 139 patients in the IMT group and 48 ( 35 % ) of 137 patients in the control group ( OR : 0.52 ; 95 % CI : 0.30 - 0.92 ) . Pneumonia occurred in 9 ( 6.5 % ) of 139 patients in the IMT group and in 22 ( 16.1 % ) of 137 patients in the usual care group ( OR : 0.40 ; 95 % CI : 0.19 - 0.84 ) . Mean duration of postoperative hospitalization was 7 ( range 5 - 41 ) days in the IMT group versus 8 ( range 6 - 70 ) days in the usual care group ( Mann-Whitney test ; Z : -2.42 ; p = 0.015 ) . CONCLUSION Preoperative physiotherapy , including IMT , statistically significantly reduced the incidence ofPPCs and the duration ofpostoperative hospitalization in patients at high risk of developing a pulmonary complication on undergoing CABG BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . The purpose of this study was to analyse the effects of preoperative physiotherapy on pain and function in 39 patients scheduled for unicompartmental prosthetic knee replacement . Nineteen patients were selected at r and om to receive preoperative physiotherapy .  The control group received no preoperative therapy . Evaluations were performed 3 months prior to surgery , immediately before and 3 months after operation . Evaluations included : Clinical assessment , measurements of the knee muscle strength , self-selected walking speed and the oxygen cost of walking . Three months before surgery the patients in both groups had similar types and levels of problems . Before surgery patients who had received physiotherapy showed slight improvements in pain , perceived stability of the knee during walking , and faster self-selected and maximal walking speeds compared to the control group , but were unchanged in muscle strength , ROM , and oxygen cost . Three months after surgery pain was significantly decreased in all patients , however , no significant differences were found between the two groups for any variable except muscle strength . This was unchanged compared to preoperative values for patients of the control group while patients who received preoperative physiotherapy showed a decrease in strength . In summary , this study did not disclose any major benefit from the program of preoperative physiotherapy tested BACKGROUND AND OBJECTIVE Pulmonary resection carries a significant morbidity and mortality . The utility of maximal oxygen uptake test ( VO(2)max ) to predict cardiopulmonary complications following major pulmonary resection was evaluated . METHODS Following st and ard preoperative work-up and VO(2)max testing , 55 patients ( 49 male ; mean age 59 years , range 20 - 74 ) underwent major pulmonary surgery : lobectomy ( n = 31 ) , bilobectomy ( n = 6 ) and pneumonectomy ( n = 18 ) . An investigator blinded to the preoperative assessment prospect ively collected data on postoperative cardiopulmonary complications . Patients were divided into two groups according to preoperative VO(2)max and also according to FEV(1 ) . The frequency of postoperative complications in the groups was compared . RESULTS Complications were observed in 19 ( 34.5 % ) patients , 11 of which were pulmonary ( 20 % ) . There were two deaths ( 3.6 % ) , both due to respiratory failure . Preoperative FEV(1 ) failed to predict postoperative respiratory complications . Five of 36 patients with a preoperative FEV(1 ) > 2 L suffered pulmonary complications , compared with six of 19 patients with FEV(1 ) < 2 L. Cardiopulmonary complications were not observed in patients with VO(2)max > 15 mL/kg/min ( n = 27 ) ; however , 11 patients with VO(2)max < 15 mL/kg/min ( n = 28 ) suffered cardiopulmonary complications ( P < 0.05 ) . CONCLUSION VO(2)max predicts postoperative pulmonary complications following major lung resection , and the risk of complications increases significantly when the preoperative VO(2)max is less than 15 mL/kg/min OBJECTIVE To evaluate the effect of a short preoperative exercise intervention on the functional status , pain , and muscle strength of patients before and after total joint arthroplasty . METHODS A total of 108 men and women scheduled for total hip arthroplasty ( THA ) or total knee arthroplasty ( TKA ) were r and omized to a 6-week exercise or education ( control ) intervention immediately prior to surgery . We assessed outcomes through question naires and performance measures . Analyses examined differences between groups over the preoperative and immediate postoperative periods and at 8 and 26 weeks postsurgery . RESULTS Among THA patients , the exercise intervention was associated with improvements in preoperative Western Ontario and McMaster Universities Osteoarthritis Index function score ( improvement of 2.2 in exercisers versus decline of 3.9 in controls ; P = 0.02 ) and Short Form 36 physical function score ( decline of 0.4 in exercisers versus decline of 14.3 in controls ; P = 0.003 ) . No significant differences were seen in TKA patients . Exercise participation increased muscle strength preoperatively ( 18 % in THA patients and 20 % in TKA patients ) , whereas the control patients had essentially no change in strength ( P > 0.05 for exercise versus education in both THA and TKA groups ) . Exercise participation prior to total joint arthroplasty substantially reduced the risk of discharge to a rehabilitation facility in THA and TKA patients ( adjusted odds ratio 0.27 , 95 % confidence interval 0.074 - 0.998 ) . The intervention had no effects on outcomes 8 and 26 weeks postoperatively . CONCLUSION A 6-week presurgical exercise program can safely improve preoperative functional status and muscle strength levels in persons undergoing THA . Additionally , exercise participation prior to total joint arthroplasty dramatically reduces the odds of inpatient rehabilitation The purpose of this prospect i ve , r and omized study was to apply an 8-week customized exercise program to patients ( Group E ) scheduled for total hip arthroplasty , followed by a postsurgery exercise program , and show the effect on functional recovery compared with control subjects ( Group C ) who received no additional exercise apart from routine in-hospital physical therapy .  Strength , range of motion , and physical function tests were completed by 57 patients at Week 8 and Week 1 before surgery and at Weeks 3 , 12 , and 24 postoperatively . No differences between the exercise and control groups were observed at baseline . By 1 week before surgery , patients in Group E had shown significant improvements for Western Ontario and McMaster Universities Osteoarthritis Index ( total score , stiffness , and physical function components ) , and combined hip strength . Patients in Group E had improved hip flexion range of motion in the diseased hip compared with patients in Group C. Significant differences in outcome measures between Group E and Group C were observed throughout the postoperative phase from Weeks 3 to 24 . The current study showed that customized perioperative exercise programs are well tolerated by patients with end-stage hip arthritis , and are effective in improving early recovery of physical function after total hip arthroplasty This study compared the effects of preoperative physical therapy or general cardiovascular conditioning exercises with the routine procedure of no preoperative physical therapy on patients undergoing primary total knee replacement . Thirty patients were r and omly assigned to 1 of 3 groups . Group 1 was the control group . Group 2 participated in a physical therapy program design ed to strengthen the upper and lower limbs and improve knee range of motion . Group 3 participated in a cardiovascular conditioning program , consisting of arm ergometry , cycle ergometry , aquatic exercises , and aerobic activity . All patients were evaluated preoperatively and postoperatively using the Hospital for Special Surgery Knee Rating , the Arthritis Impact Measurement Scale , and the Quality of Well Being instrument . Both experimental groups tolerated their respective exercise protocol s extremely well . All 3 groups showed significant improvement postoperatively as measured by the Hospital for Special Surgery Knee Rating , the Arthritis Impact Measurement Scale and the Quality of Well Being measurement scales . However , neither type of preoperative exercise added to the degree of improvement after surgery at any of the postoperative evaluations OBJECTIVE Dislocation is a well-known complication after  total hip arthroplasty ( THA ) , and is the second-highest cause of revision surgery . Our objective was to assess the effect of preoperative patient education on the occurrence of  hip dislocation  within 6 months after primary THA . METHODS Between 1998 and 2007 , we conducted a prospect i ve cohort study at the Geneva University Hospital Department of Orthopaedic Surgery , including all primary THAs performed via an anterolateral transgluteal approach with the use of a 28-mm diameter head .  The preoperative education session was introduced in June 2002 and included advice on muscle strengthening exercises and postoperative restrictions of range of motion as a means of preventing dislocation . The main outcome was the incidence of dislocation within 6 months of surgery . RESULTS A total of 597 patients who underwent 656 THAs between June 2002 and June 2007 participated in the education session , whereas 1,641 patients who underwent 1,945 procedures did not . Forty-six dislocations occurred over the study period , 5 ( 0.8 % ) in participants and 41 ( 2.1 % ) in non participants ( absolute risk reduction 1.3 % ; 95 % confidence interval [ 95 % CI ] 0.4 , 2.3 ) , with the time interval between surgery and dislocation being significantly shorter among participants ( 0.2 versus 1.2 months ) . Non participants had a 2.8 times higher risk of dislocation than participants ( unadjusted odds ratio [ OR ] 2.80 ; 95 % CI 1.10 , 7.13 ) . Adjustment for age , sex , comorbidities , and prior surgery did not change the results ( adjusted OR 2.79 ; 95 % CI 1.09 , 7.15 ) . CONCLUSION Our findings suggest that participation in a preoperative patient education session may reduce the risk of dislocation within 6 months after THA Pulmonary complications after cardiac surgery are a leading cause of postoperative morbidity and mortality . Respiratory muscle weakness may contribute to the postoperative pulmonary abnormalities . We hypothesized that : ( 1 ) there is a decrease in inspiratory muscle strength ( PImax at residual volume ) and endurance ( Pmpeak/PImax ) following coronary artery bypass graft ( CABG ) ; ( 2 ) this weakness is associated with reduced pulmonary function tests ( PFTs ) , impaired gas exchange , and a higher rate of pulmonary complications ; and ( 3 ) prophylactic inspiratory muscle training ( IMT ) can prevent those changes . Eighty-four c and i date s for CABG , with ages ranging from 33 to 82 years , were evaluated prior to operation and r and omized into two groups : 42 patients underwent IMT using a threshold trainer for 30 min/day for 2 weeks , 1 month before operation ( group A ) ; 42 patients served as a control group and underwent sham training ( group B ) . There was a significant decrease in respiratory muscle function , PFTs , and gas exchange in the control group following CABG , whereas these parameters remained similar to those before entering the study in the training group . The differences between the groups were statistically significant . In addition , 11 ( 26 % ) patients in the control group but only 2 ( 5 % ) in the training group needed postsurgical mechanical ventilation longer than 24 hours . CABGs have a significant deteriorating effect on inspiratory muscle function , PFTs , and arterial blood gases . The decrease in these parameters can be prevented by prophylactic inspiratory muscle training , which may also prevent postsurgical pulmonary complications OBJECTIVE The purpose of this study was to examine the effect of a preoperative exercise intervention on knee pain , functional ability , and quadriceps strength among patients with knee osteoarthritis before and after total knee arthroplasty ( TKA ) surgery . DESIGN A repeated- measures design was used to compare 2 groups over 4 data collection points . SETTING AND PATIENTS Community-dwelling subjects with osteoarthritis of the knee who were scheduled for a unilateral TKA were recruited from a single orthopedic surgeon 's office and were r and omized into control ( n = 28 ) or prehab groups ( n = 26 ) . INTERVENTIONS The control patients maintained usual care before their TKA . The exercisers performed prehabilitation exercises , which included resistance training , flexibility , and step training , 3 times per week before their TKA . OUTCOME MEASURES Knee pain , functional ability , quadriceps strength , and strength asymmetry were assessed at baseline ( T1 ) , at 1 week before the patients ' TKA ( T2 ) , and again at 1 ( T3 ) and 3 ( T4 ) months after TKA . RESULTS The exercisers improved their sit-to-st and performance at T2 , whereas the control group did not change their performance of functional tasks and had increased pain at T2 . At T3 the exercisers demonstrated improved sit-to-st and performance . The control patients at T3 exhibited decreases in pain , their 6-minute walk , surgical leg strength and an increase in their nonsurgical leg strength and leg strength asymmetry . At T4 the exercisers improved in their performance of 3 of the 4 functional tasks , decreased all of their pain measures , and increased their surgical and nonsurgical quadriceps strength . At T4 the control group improved their performance on 2 of the 4 functional tasks , decreased all of their pain measures , increased their nonsurgical leg strength , and exhibited greater leg strength asymmetry . CONCLUSION These findings appear to indicate the efficacy of prehabilitation among TKA patients and support the theory of prehabilitation
target: Preoperative exercise therapy consisting of inspiratory muscle training or exercise training prior to cardiac or abdominal surgery led to a shorter hospital stay and reduced postoperative complication rates .
  By contrast , length of hospital stay and complication rates of patients after joint replacement surgery were not significantly affected by preoperative exercise therapy consisting of strength and /or mobility training .
  Conclusion : Preoperative exercise therapy can be effective for reducing postoperative complication rates and length of hospital stay after cardiac or abdominal surgery .
background: Objective : To summarize the current evidence on the effects of preoperative exercise therapy in patients awaiting invasive surgery on postoperative complication rate and length of hospital stay .