Preoperative Physiotherapy for the Prevention of Respiratory Complications after Upper Abdominal Surgery

Running Head: NSG2204- Evidence Based Practice
Assessment
NSG2204- Evidence Based Practice
Critical Appraisal
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NSG2204- Evidence Based Practice 2
Selected Paper
Boden,I., Skinner,E., Browning,L., Reeve,J., Anderson,L., Hill,C., Robertson,I.,Story,D. &
Denehy,L.(2018). Preoperative physiotherapy for the prevention of respiratory complications
after upper abdominal surgery: pragmatic, double blinded, multicentre randomized controlled
trial. BMJ 2018. 360(j5916). 1-15. Doi: http://dx.doi.org/10.1136/bmj.j5916
Introduction
The post operative respiratory complications are considered as a significant risk factor for deaths
in respiratory wards after surgery. The prevalence contributes to 10-50% of deaths in all patients
every year globally (Diaz, 2016). In this study, the authors assessed the effectiveness of
preoperative physiotherapy sessions which instruct the patients to immediately start breathing
after surgery. This exercise just halves the risk for the patients to have post operative
complications. However, its effectiveness for non thoracic surgeries is not evidenced by adequate
literature support.
This study aims to analyze the effectiveness of these interventions at 3 tertiary public hospitals in
New Zealand and Australia. The abstract clearly identifies the objective, design, setting,
participants, interventions, main outcome measures, results and conclusion along with details of
trial registration. In the introduction, the authors clearly mentioned the context where the
preoperative education interventions have not been tested so far, like in case of enhanced
recovery and minimally invasive surgery. Authors have done a good practice by identifying the
scope of the paper. The authors also identified the methodological bias of single center trials, low
risk surgical cohorts and non masked assessors as confounding factors which may limit the effect
of the intervention.
Literature Review
The evidences in the article supported the aim of the study and the hypothesis of Lung Infection
Prevention Post Surgery Major Abdominal with Pre-Operative Physiotherapy (LIPPSMAck-

NSG2204- Evidence Based Practice 3
POP) trial, through empirical analysis. The paper is multicentre, pragmatic, assessor and patient
blinded, placebo controlled trial. The authors were sensitive to the health condition of the
recruitment samples. They excluded the patients who were inpatients or needed organ transplant,
or were not able to take part in the study. Prior to randomization, the patients were informed
about the structure and details of study and informed consent was taken.
The process of allocation of control and intervention group was truly random as the numbers of
patients to be allocated to each group was randomly provided by independent administrators in
blinded approach. The physiotherapists and site investigators who knew the group allocation
were not allowed contact with patients after surgery.
The participants and their carers were asked for their consent prior to inclusion in study. As the
participants were vulnerable to be maltreated during the follow up for 12 months, it is imperative
for such studies to follow the global standards and ethical principles for protecting them from
any unethical treatment (Goldstein, 2018). The authors detailed each minute of the training and
awareness program delivered by the physiotherapists before the surgery with help of information
booklets, email and telephonic instructions. The post operative diagnostic tool was used to assess
the pulmonary complications after surgery. The authors identified the primary and secondary
outcomes after the operation.
The criteria used to assess their eligibility were based on standard face to face assessment and
interviews. The author chosen standard approach to collect the empirical data related to patients
in ethically compliance way. The authors followed the treatment for both the groups for a long