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Association of Chartered Physiotherapists in Respiratory Care scoping review: Post-operative physiotherapy management in upper gastrointestinal (GI) surgery

Objective This scoping review will identify and synthesise the available evidence for post-operative physiotherapy following upper GI surgery, in order to identify gaps in the literature, inform evidence-based practice and contribute towards guidelines and/or policy development. Introduction Physiotherapy management following thoracic, cardiac and upper gastrointestinal surgery has been identified as one of the five key priorities for review by the Association of Chartered Physiotherapists in Respiratory Care (ACPRC) editorial board. Previously, systematic reviews have been published with a focus on one type of physiotherapy treatment. The aim of this scoping review was to identify all types of post-operative physiotherapy following upper GI surgery research to provide a comprehensive review of available evidence. Inclusion criteria Studies with adult patients undergoing upper GI surgery and published between 2015 and 2020 were included. The surgical procedure included required post-operative physiotherapy intervention as part of the recovery process. The context was in-patient, hospital-based surgery. Physiotherapy intervention prior to admission (such as pre-habilitation), and intervention after hospital discharge, for example, out-patient follow up were excluded. Research from any country of origin and any type of healthcare system was included. Methods The search strategy was agreed by the scoping team and searches were undertaken of PEDro, CINAHL, EMBASE, MEDLINE, PubMed, Google Scholar and the Clinical Trials Registry. Exclusion criteria included any articles not written in English. All identified citations were uploaded into web-based Endnote. Articles were screened against title and abstract by one reviewer, and full text articles were appraised by two reviewers. Data extraction included the aim of the study, design/methodology, sample details (number of participants, mean age, gender ratio), comparison group details, outcome measures, and key findings relevant to the scoping review questions. Quality was assessed using the relevant Critical Appraisal Skills Programme (CASP) or Joanna Briggs Institute (JBI) tools dependent on study methodology. Results Eleven studies were identified for inclusion of which there were three randomised control trials (RCT), four cohort studies, one systematic review, one cross sectional study, one narrative review and one survey. No qualitative studies were found. Four studies considered the role of adjuncts (incentive spirometry and inspiratory muscle training). Five studies investigated ambulation or early mobilisation post-surgery, one study looked at the role of pre-operative education and one study looked at current practise. 57 physiotherapists were surveyed, 1,384 participants were included in studies and 37 papers were included in reviews. The studies found that early and intensive mobilisation as part of an ERAS programme showed a statistically significant reduction in length of stay (LOS) and post-operative pulmonary complications (PPCs). Reported physiotherapy interventions are in line with current best practice guidelines. IMT and IS continue to show positive results in the literature in particular in the older and high-risk patient. Pre-operative assessment and education should be considered in patients undergoing upper abdominal GI surgery however screening tools for prioritisation are not yet established. The quality of the research was generally good; however, sample sizes were small and often underpowered. Conclusions This scoping review has demonstrated that current evidence supports post-operative physiotherapy intervention in people who undergo upper GI surgery. Future research should aim to determine the role of pre-operative physiotherapy, clarify the impact of breathing exercise protocols and expand the diversity of methodologies to include more qualitative research.