Editorial
Impact of a Pre-Operative Pulmonary Rehabilitation Program on Functional Performance In Patients Undergoing Video-assisted Thoracic Surgery for Lung Cancer
Impacto de un programa de rehabilitación pulmonar preoperatoria sobre el rendimiento funcional de pacientes sometidos a cirugía torácica asistida por vídeo debido a neoplasia maligna pulmonar
Raquel Sebioa,
, Maria I. Yáñez-Bragea, Esther Giménez-Moolhuyzenb, Marie C. Valenzac, Gregory Reychlerd, Larry P. Cahaline
Corresponding author
a Departamento de Fisioterapia, Facultad de Fisioterapia, Grupo de Investigación en Intervención Psicosocial y Rehabilitación Funcional, Universidad de A Coruña, A Coruña, Spain
b Servicio de cirugía Torácica, Hospital Universitario de A Coruña, A Coruña, Spain
c Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, Spain
d Servicio de Neumología y Medicina Física, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Louvain, Brussels, Belgium
e Departamento de Fisioterapia, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
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Yáñez-Brage, Esther Giménez-Moolhuyzen, Marie C. Valenza, Gregory Reychler, Larry P. Cahalin" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Raquel" "apellidos" => "Sebio" "email" => array:1 [ 0 => "raquelsebio@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Maria I." "apellidos" => "Yáñez-Brage" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Esther" "apellidos" => "Giménez-Moolhuyzen" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Marie C." 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"apellidos" => "Cahalin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Departamento de Fisioterapia, Facultad de Fisioterapia, Grupo de Investigación en Intervención Psicosocial y Rehabilitación Funcional, Universidad de A Coruña, A Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de cirugía Torácica, Hospital Universitario de A Coruña, A Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Neumología y Medicina Física, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Louvain, Brussels, Belgium" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamento de Fisioterapia, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto de un programa de rehabilitación pulmonar preoperatoria sobre el rendimiento funcional de pacientes sometidos a cirugía torácica asistida por vídeo debido a neoplasia maligna pulmonar" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The role of pulmonary rehabilitation in lung cancer has been systematically reviewed in the literature and it has been recommended as part of the pre-operative management to enhance recovery after thoracic surgery.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> However, few studies have focused on patients undergoing video-assisted thoracic surgery (VATS). To fill this research gap, we designed a pilot study to investigate the effects of a preoperative pulmonary rehabilitation program in patients awaiting VATS for lung cancer.</p><p id="par0010" class="elsevierStylePara elsevierViewall">From February 2013 to June 2013, 23 patients were screened at the University Hospital of A Coruna. Patients who agreed to participate gave written informed consent before any formal testing. The research protocol was approved by the local ethics committee.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The rehabilitation program consisted of one and a half hour sessions, 3–5 times per week during the preoperative period, including: (1) interval aerobic training on a cycloergometer for 30–40<span class="elsevierStyleHsp" style=""></span>minutes; (2) resistance training with elastic bands and body-weight exercises for 3 sets of 15 repetitions each; and (3) breathing exercises with an incentive spirometer twice daily.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Participants were evaluated at 4 time points: at baseline (T<span class="elsevierStyleInf">0</span>); prior to surgery (T<span class="elsevierStyleInf">1</span>); at hospital discharge (T<span class="elsevierStyleInf">2</span>); and 3 months after surgery (T<span class="elsevierStyleInf">3</span>). Functional capacity measured with the 6-minute walking test (6MWT) was the main study endpoint. Other outcomes included muscle strength measured with the Senior Fitness Test (SFT),<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> health-related quality of life (HRQoL) measured with the Short-Form 36 Health Survey (SF36), and postoperative outcomes (incidence of postoperative complications and hospital stay).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Non-parametric tests were used to examine difference across time in the main outcomes. Univariate and multivariate regression analyses were used to identify the potential risk factors associated with a decrease in postoperative functional capacity. Analyses were performed using SPSS for Windows.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Twelve patients met the inclusion criteria and entered the rehabilitation program. Two patients withdrew and another was excluded because surgery was brought forward, leaving 9 patients (mean age was 68.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.4 years, 8 men), who attended a median of 21 sessions (range 11–27; mean adherence: 125.7%). Six patients underwent lobectomy and 3 had wedge resection. Postoperative complications occurred in 2 patients (prolonged air leak in 2 and 1 with pneumothorax).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Main outcomes are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. An almost significant increase was found in the 6MWT after rehabilitation (<span class="elsevierStyleItalic">P</span>=.050). The 2 SFT items were also significantly improved (<span class="elsevierStyleItalic">P</span><.05). HRQoL was less than normal at baseline. No significant changes were observed in any domain of the SF36 except for the Mental Health Subscale (<span class="elsevierStyleItalic">P</span>=.041). After surgery, all items decreased, especially the physical role (<span class="elsevierStyleItalic">P</span>=.012). Univariate analysis indicated that postoperative 6MWT was highly correlated with baseline FEV<span class="elsevierStyleInf">1</span>, baseline physical functioning, and baseline physical summary component (PCS) of the SF36. The multivariate analysis confirmed that the PCS was a strong, independent factor for postoperative decline in the 6MWT (<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span>=.581).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The results of this pilot study suggest that a preoperative pulmonary rehabilitation program for patients undergoing VATS is feasible and appears to improve functional capacity and muscle strength. This finding is consistent with earlier studies in individuals undergoing thoracotomy<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> and should be considered as a method for optimizing patients’ status before surgery and for increasing the number of candidates for surgical resection. The borderline improvement found in the 6MWT could be explained by the ceiling effect observed in individuals who are already fit (defined as baseline 6MWT 124.6% predicted) and the lack of responsiveness of the test in this scenario. Even so, it achieved the minimal clinically important difference reported for the lung cancer population.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Our results also confirm earlier findings in sedentary and elderly populations,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> suggesting that in the absence of more sophisticated equipment, elastic bands are an effective way of improving muscle strength in individuals with lung cancer. Unfortunately, no significant changes were found in HRQoL after training. Further studies are required in larger series to address this issue. A randomized controlled trial is also needed to investigate whether these functional improvements can lead to a reduction in postoperative complications and length of stay, in comparison to standard care.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authorship</span><p id="par0045" class="elsevierStylePara elsevierViewall">Raquel Sebio was the main investigator in this research. She was responsible for the design of the Preoperative Pulmonary Rehabilitation Program (PPRP), obtaining ethical approval, and conducting the screening and initial evaluation of the patients. She also contributed to the writing process.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Esther Gimenez Moolhuyzen was responsible for the implementation of the PPRP and evaluation of patients.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Isabel Yáñez Brage is Raquel Sebio's supervisor. She also contributed to the design of the PPRP.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Carmen Valenza, Gregory Reychler and Larry Cahalin were experts who advised on the design of the PPRP. They also contributed to the writing process and statistical analysis.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Authorship" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as: Sebio R, Yáñez-Brage MI, Giménez-Moolhuyzen E, Valenza MC, Reychler G, Cahalin LP. Impacto de un programa de rehabilitación pulmonar preoperatoria sobre el rendimiento funcional de pacientes sometidos a cirugía torácica asistida por vídeo debido a neoplasia maligna pulmonar. Arch Bronconeumol. 2016;52:231–232.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T<span class="elsevierStyleInf">0</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T<span class="elsevierStyleInf">1</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T<span class="elsevierStyleInf">3</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6MWT (m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">557.56 (74.43<span class="elsevierStyleBold">)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">580.11 (80.67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">489.67 (98.69)<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">**</span></a>,<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">†</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">529.63 (83.23) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Curl-Arm Test (number) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.89 (5.34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.67 (2.64)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (3.28)<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.25 (3.19)<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">††</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chair Sit-To-Stand Test (number) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.56 (5.91) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.86 (3.93)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.11 (4.98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.22 (6.98) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035909.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><span class="elsevierStyleItalic">P</span><.05 between T<span class="elsevierStyleInf">0</span> and T<span class="elsevierStyleInf">1</span>.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "**" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Between T<span class="elsevierStyleInf">0</span> and T<span class="elsevierStyleInf">2</span>.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "†" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Between T<span class="elsevierStyleInf">1</span> and T<span class="elsevierStyleInf">2</span>.</p>" ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "††" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Between T<span class="elsevierStyleInf">0</span> and T<span class="elsevierStyleInf">3</span>.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Main Study Outcomes (Mean and Standard Deviation).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review of enhanced recovery for thoracic anaesthesia and surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N.L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 4 | 7 |
| 2024 October | 48 | 25 | 73 |
| 2024 September | 62 | 19 | 81 |
| 2024 August | 78 | 57 | 135 |
| 2024 July | 48 | 24 | 72 |
| 2024 June | 77 | 41 | 118 |
| 2024 May | 113 | 27 | 140 |
| 2024 April | 54 | 44 | 98 |
| 2024 March | 57 | 23 | 80 |
| 2024 February | 35 | 24 | 59 |
| 2023 April | 9 | 0 | 9 |
| 2023 March | 10 | 6 | 16 |
| 2023 February | 69 | 18 | 87 |
| 2023 January | 73 | 49 | 122 |
| 2022 December | 61 | 41 | 102 |
| 2022 November | 61 | 35 | 96 |
| 2022 October | 56 | 31 | 87 |
| 2022 September | 46 | 44 | 90 |
| 2022 August | 57 | 36 | 93 |
| 2022 July | 27 | 41 | 68 |
| 2022 June | 29 | 31 | 60 |
| 2022 May | 52 | 53 | 105 |
| 2022 April | 47 | 36 | 83 |
| 2022 March | 49 | 51 | 100 |
| 2022 February | 59 | 47 | 106 |
| 2022 January | 48 | 34 | 82 |
| 2021 December | 56 | 45 | 101 |
| 2021 November | 47 | 58 | 105 |
| 2021 October | 71 | 42 | 113 |
| 2021 September | 53 | 51 | 104 |
| 2021 August | 51 | 48 | 99 |
| 2021 July | 46 | 33 | 79 |
| 2021 June | 75 | 45 | 120 |
| 2021 May | 47 | 36 | 83 |
| 2021 April | 79 | 91 | 170 |
| 2021 March | 119 | 40 | 159 |
| 2021 February | 34 | 28 | 62 |
| 2021 January | 40 | 32 | 72 |
| 2020 December | 45 | 11 | 56 |
| 2020 November | 34 | 22 | 56 |
| 2020 October | 44 | 11 | 55 |
| 2020 September | 42 | 16 | 58 |
| 2020 August | 36 | 18 | 54 |
| 2020 July | 38 | 25 | 63 |
| 2020 June | 45 | 25 | 70 |
| 2020 May | 36 | 24 | 60 |
| 2020 April | 53 | 44 | 97 |
| 2020 March | 39 | 19 | 58 |
| 2020 February | 92 | 23 | 115 |
| 2020 January | 40 | 26 | 66 |
| 2019 December | 40 | 24 | 64 |
| 2019 November | 47 | 34 | 81 |
| 2019 October | 67 | 26 | 93 |
| 2019 September | 38 | 16 | 54 |
| 2019 August | 33 | 21 | 54 |
| 2019 July | 30 | 30 | 60 |
| 2019 June | 49 | 15 | 64 |
| 2019 May | 64 | 25 | 89 |
| 2019 April | 35 | 38 | 73 |
| 2019 March | 42 | 26 | 68 |
| 2019 February | 43 | 20 | 63 |
| 2019 January | 83 | 26 | 109 |
| 2018 December | 38 | 36 | 74 |
| 2018 November | 71 | 24 | 95 |
| 2018 October | 88 | 33 | 121 |
| 2018 September | 22 | 12 | 34 |
| 2018 May | 26 | 1 | 27 |
| 2018 April | 36 | 15 | 51 |
| 2018 March | 36 | 7 | 43 |
| 2018 February | 32 | 11 | 43 |
| 2018 January | 27 | 16 | 43 |
| 2017 December | 35 | 9 | 44 |
| 2017 November | 25 | 17 | 42 |
| 2017 October | 29 | 14 | 43 |
| 2017 September | 30 | 9 | 39 |
| 2017 August | 25 | 22 | 47 |
| 2017 July | 21 | 11 | 32 |
| 2017 June | 35 | 13 | 48 |
| 2017 May | 38 | 18 | 56 |
| 2017 April | 20 | 15 | 35 |
| 2017 March | 17 | 14 | 31 |
| 2017 February | 31 | 14 | 45 |
| 2017 January | 14 | 10 | 24 |
| 2016 December | 34 | 28 | 62 |
| 2016 November | 41 | 23 | 64 |
| 2016 October | 46 | 25 | 71 |
| 2016 September | 44 | 8 | 52 |
| 2016 August | 60 | 15 | 75 |
| 2016 July | 2 | 0 | 2 |
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