however , 
 many such patients , particularly those with severe chronic obstructive pulmonary disease , 
 have a high risk of postoperative pulmonary complications1 . there is growing interest in the use of non - pharmacological 
 interventions after lung resection or during cancer care , such as radiation therapy and 
 chemotherapy . pulmonary rehabilitation ( pr ) has been proposed to decrease the risk of 
 postoperative pulmonary complications2 . it 
 is necessary to develop a home - based exercise program to improve the function of patients 
 and prevent postoperative pulmonary complications because the out - patient period is longer 
 than the in - patient period . however , previous studies have focused mainly on pr for 
 in - patients or only hospital workers , such as doctors , nurses , physical therapists , and 
 respiratory therapists , provided the pr . few studies on education programs for caregivers , 
 which are the main supporters of home - based exercise programs during the outpatient period , 
 have been conducted . the aim of this study was to evaluate the effects of a pr education 
 program for caregivers on pulmonary function and pain in patients with lung cancer after 
 lung resection . the subjects comprised patients hospitalized within the department of thoracic surgery of a 
 national university hospital between march and november 2013 who had not previously partaken 
 in a pulmonary rehabilitation education program for caregivers and were scheduled for lung 
 resection . this study was approved by the national university hospital of health science 
 human ethics committee ; all subjects provided written informed consent prior to 
 participation . during the hospital stay for the surgery , all 50 subjects received the same 
 general management ( typical care ) and were randomly divided into an experimental group ( n = 
 25 ) and a control group ( n = 25 ) . three subjects dropped out of the experimental group , and 
 six dropped out of the control group during the 4-week study due to application of the 
 exclusion criteria . therefore , the study was completed with 22 subjects in the experimental 
 group and 19 in the control group . patients with other cardiopulmonary diseases , a 
 congenital chest deformity , or rib fractures were excluded . after surgery , patients who 
 received additional chemotherapy that weakened their body function were also excluded , as 
 were those who did not attend the weekly pr education program . the assessments of subjects 
 were performed by a physical therapist who was blinded to any information about the groups . the control group received the entire typical care program , including pain management , 
 general education for postoperative care , incentive spirometer use training , mobilization of 
 the upper limbs and trunk , and nebulizer use instructions from the department of thoracic 
 surgery . the experimental group partook in the pr education program for caregivers once per 
 week for 30  min , under the direction of a physical therapist instructor . the pr education 
 program included instruction regarding splint cough , airway clearance techniques , diaphragm 
 breathing , segmental breathing , exercises for upper and lower extremities , walking 
 exercises , and stair exercises . the instructor demonstrated the procedures to caregivers , 
 and then the caregivers practiced with their patients while the instructor observed . cambridge , uk ) . forced 
 vital capacity ( fvc ) and forced expiratory volume in 1 sec ( fev1 ) were measured in 
 accordance with the american thoracic society guidelines3 . data were encoded and 
 analyzed using spss for windows ver . 12.0 ( spss , the homogeneity of the general characteristics 
 between the two groups was analyzed by  test and independent t - test . the 
 differences in the changes between the two groups before the experiment and at 2 weeks 
 ( baseline ) and 6 weeks after surgery ( 4 weeks ) were assessed by repeated - measures analysis 
 of variance . the average age , height , weight , and bmi of subjects were 60.22  10.89 , 163.01  8.77  cm , 
 61.39  11.35  kg , and 23.01  3.34 , respectively . pulmonary function ( fvc and fev1 ) in the 
 experimental group increased significantly compared with that in the control group ( p < 
 0.01 ) ( table 1table 1.comparison of pulmonary function and painmean ( sd)controlexperimentalfvcbaseline1.89 ( 0.45)1.90 ( 0.47)4 weeks2.00 ( 0.44)2.30 ( 0.44)fev1baseline1.63 ( 0.43)1.71 ( 0.37)4 weeks1.62 ( 0.42)1.95 ( 0.36)vasbaseline3.15 ( 2.13)3.54 ( 2.09)4 weeks2.73 ( 1.82)2.23 ( 1.60)p<0.01 ) . vas scores at 4 weeks and baseline differed significantly , but no 
 differences were observed over time or among groups ( table 1 ) . filaire et al.5 reported that the 
 fev1/fvc ratio did not change , but the inspiratory and expiratory reserve volume decreased 
 rapidly by ~40% in the acute stage after lung resection in 31 patients with lung cancer 
 ( mean age , 59  10  years ) . varela et al.6 
 showed that fev1 decreased rapidly 1 day after surgery and then recovered slowly during the 
 next 6 days , but it did not reach the previous level . our results were similar , as the 
 fev1/fvc ratio at baseline was 0.86 in the control group and 0.90 in the experimental group . however , the change in fvc differed before and after the experiment , as that in the 
 experimental group increased by 21.1% compared with 5.8% in the control group . this was 
 believed to be caused by the short study period ( 4 weeks ) and the fact that each group 
 received a different intervention . in contrast , a pilot study by spruit et al.7 , applied an 8-week pr exercise program to 
 inpatients who had undergone lung resection for lung cancer : all pulmonary functions , with 
 the exception of fev1 , differed significantly , including functional exercise capacity . it 
 would appear that the pr education program for caregivers , designed to improve pulmonary 
 function ( fvc and fev1 ) , was responsible for these differences : the previous study had 
 focused on strengthening and aerobic exercises , such as walking . the pulmonary 
 rehabilitation education program for caregivers had a positive effect on pulmonary function 
 in patients with lung cancer following lung resection . in a previous study , the pain score 
 ( vas ) of patients who had undergone lung resection was 3.3 immediately after surgery , 2 at 2 
 weeks , and 1.5 at 6 weeks after surgery8 . 
 in our study , the vas revealed significantly decreased pain in both groups , but no 
 difference was observed between the two groups .
[ purpose ] the purpose of this study was to evaluate the effects of a pulmonary 
 rehabilitation education program for caregivers on patients who underwent lung resection 
 surgery . 
 [ subjects ] subjects who underwent lung resection by visual assisted thoracotomy 
 ( vats ) were selected and divided into a control group of 19 and an experimental group of 
 22 . 
 [ methods ] the experimental group received a pulmonary rehabilitation education program 
 for caregivers , while the control group received typical care for 4 weeks . 
 this study 
 assessed the subjects 2 weeks ( baseline ) and 6 weeks after surgery ( 4 weeks ) . 
 the forced 
 vital capacity ( fvc ) and forced expiratory volume in 1 sec ( fev1 ) were measured to 
 evaluate pulmonary function . a visual analogue scale ( vas ) 
 was utilized to evaluate pain . 
 [ results ] pulmonary function ( fvc and fev1 ) increased more in the experimental group 
 compared with the control group . 
 furthermore , vas scores were lower in the experimental 
 group compared with the control group . 
 [ conclusion ] a pulmonary rehabilitation education 
 program for caregivers had a positive effect on pulmonary function in patients with lung 
 cancer after lung resection .