上腹部手術のプレハビリテーション

上腹部手術のプレハビリテーション（術前理学療法）による呼吸機能と身体機能の効果をみたRCTを紹介します。

Silvia Maria de Toledo Piza Soares, et al. Pulmonary function and physical performance outcomes with preoperative physical therapy in upper abdominal surgery: a randomized controlled trial. Clin Rehabil, February 12, 2013, doi: 10.1177/0269215512471063

リサーチクエスチョンは以下の通りです。

P：上腹部手術を受ける患者32人にに
I：プレハビリテーション（手術2-3週間前からの呼吸リハと全身運動）を行うと
C：行わない場合と比較して
O：呼吸機能と身体機能が改善する
D：RCT

結果ですが、介入群では術前の呼吸筋の筋力と持久力が有意に改善しました。術後7日目には介入群でFIM総得点（118対95）と6分間歩行距離（368.5m対223m）が有意に改善しました。術後の呼吸器合併症は介入群5人、対象群11人と介入群で有意に少なかったです。

以上より、上腹部手術のプレハビリテーション（術前理学療法）によって、呼吸機能と術後の身体機能が改善するという結論です。ただし、術後の入院期間は両群とも中央値8.5日で有意差はありません。術後30日目のFIM総得点と6分間歩行距離にも有意差はありません。

プレハビリテーションの期間が2-3週間（週2回、1回50分）というのは実現可能性の点ではよいと思います。術前にADL全自立の患者に対するプレハビリテーションでも、早期回復に寄与する可能性はあるといえます。中期的には大差なしとなりますが。

Abstract

Objective: Investigation of the effects of preoperative physical therapy on pulmonary function and physical performance before and after upper abdominal surgery.

Design: Non-blind randomized controlled trial.

Setting: Tertiary public hospital and private university, São Paulo state, Brazil.

Subjects: Thirty-two patients undergoing abdominal surgery.

Interventions: Patients were randomly assigned to receive physical therapy, with respiratory and global exercises, 2–3 weeks before surgery (treatment group; n = 16) or await operation without engaging in practicing (control group; n = 16). After surgery, a physical therapy protocol was administered to all subjects until the seventh postoperative day.

Main measures: Pulmonary function outcome variables were inspiratory and expiratory strength, respiratory muscle endurance and spirometry, and physical performance outcome variables were the functional independence measure and 6-minute walk test distance. Any postoperative pulmonary complications were recorded.

Results: There were no between-group differences at randomization. In the preoperative period, patients in the intervention group had higher inspiratory strength and respiratory muscle endurance than controls (88 cmH₂O versus 64 cmH₂O and 28 cmH₂O versus 23 cmH₂O, respectively; P ＜0 0.05). On the seventh postoperative day, in addition to inspiratory force and respiratory muscle endurance, the intervention group showed better results than controls in the functional independence measure score (118 versus 95) and 6-minute walk test distance (368.5 m versus 223 m), all P ＜0 0.05. Postoperative pulmonary complications occurred in 11 patients in the control group and five in the intervention group (P = 0.03).

Conclusion: Preoperative physical therapy improved pulmonary function and physical performance in the pre- and postoperative periods among patients undergoing upper abdominal surgery.