Preoperative Physiotherapy for the Prevention of Respiratory Complications after Upper Abdominal Surgery: Pragmatic, Double Blinded, Multicentre Randomised Controlled Trial

Boden I, Skinner EH, Browning L et al.

British Medical Journal 2017, 360:j5916

Aim of Study

To determine whether a single preoperative physiotherapy coaching and education session prior to upper abdominal surgery  reduces the risk of operative pulmonary complications.

Design and Location

Prospective, pragmatic, multicentre, patient and assessor blinded, randomised controlled superiority trial, in preassessment clinics at three tertiary hospitals in Australia and New Zealand.


Random assignment during routine preassessment clinics to either control group (information booklet about post operative respiratory complications and breathing exercises to reduce them) or intervention (booklet, followed by one-on-one education session and breathing exercise coaching)

Primary Outcome

Post-operative pulmonary complications (PCPs) as per the Melbourne Group Score within 14 days

Secondary Outcomes

Pneumonia, length of stay, time to ambulation, HDU/ICU admission and length of stay, costs, self-reported quality of life assessments (SF-36 at 6 weeks), readmissions, mortality.


Backwards stepwise regression for baseline covariates, post hoc sensitivity analyisis for effect of covariates, powered to detect difference 10% absolute risk reduction from 20% baseline risk.


Incidence of PCPs within 14 days was halved, adjusted hazard ratio 0.48, 95% CI 0.30-0.70, P = 0.001), with absolute risk reduction 15%, (95% CI 7%-22%), NNT 7  (95% CI 5 to 14). No differences in other secondary outcomes.


Strong evidence for a single preoperative physiotherapy session reducing risk of PCPs, and recall of specific breathing exercises and rationale recalled by 94% vs 15% in control group.

Stated Limitations from the Study

Not adequately powered to detect any ongoing trends such as length of stay in mortality though trend towards this.

Discussion from Journal Club Meeting (?Change of Practice)

Robust paper, however despite showing reduction in PCPs, what real world impact does this have as no secondary outcomes were reduced. Perhaps larger studies would be able to demonstrate this. There would perhaps be more economical ways to implement this perhaps with video training in larger groups.

Summary by Dr A Beverly. Journal Club 15 February 2018.

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