Preoperative physiotherapy prior to abdominal surgery is memorable and has high impact: a mixed methods study

Ms Ianthe Boden1,2, Ms Nadia Zalucki1, Dr Doa El-Ansary2, Dr Laura Browning2,3, Dr Elizabeth Skinner2,3, Professor Linda Denehy2

1Launceston General Hospital, West Launceston, Australia, 2Physiotherapy Department, University of Melbourne, Melbourne, Australia, 3Division of Allied Health, Western Health, Footscray, Australia

Objectives: To; 1) assess memorability and treatment fidelity of preoperative physiotherapy education prior to elective upper abdominal surgery and, 2) to explore patient opinions on preoperative education. Design: Mixed-methods analysis of a convenience sample within a larger parallel-group, double-blinded, randomised controlled trial with concealed allocation and intention-to-treat analysis. Setting: Tertiary Australian hospital. Participants: Twenty-nine patients having upper abdominal surgery attending preadmission clinic within six-weeks of surgery. Intervention: The control group received an information booklet about preventing pulmonary complications with early ambulation and breathing exercises.  The experimental group received an additional face-to-face 30-minute physiotherapy education and training session on pulmonary complications, early ambulation, and breathing exercises. Outcome measures: Primary outcome was proportion of participants who remembered the taught breathing exercises following surgery. Secondary outcomes were recall of information sub-items and attainment of early ambulation goals. These were measured using standardised scoring of a semi-scripted digitally-recorded interview on the 5th postoperative day, and the attainment of early ambulation goals over the first two postoperative days. Results: Experimental group participants were six-times more likely to remember the breathing exercises (95% CI 1.7 to 22) and 11-times more likely (95%CI 1.6 to 70) to report  physiotherapy as the most memorable part of preadmission clinic. Participants reported physiotherapy education content to be detailed, interesting, and of high value. Some participants reported not reading the booklet and professed a preference for face-to-face information delivery. Conclusion: Face-to-face preoperative physiotherapy education and training prior to upper abdominal surgery is memorable and has high treatment fidelity.


Ianthe Boden is the Cardiorespiratory Team Leader at the Launceston General Hospital. Ianthe is currently completing a PhD at The University of Melbourne investigating the prevention of pulmonary complications following abdominal surgery. Ianthe’s first randomised controlled trial, LIPPSMACK-POP, has won major research prizes at Physiotherapy, Anaesthetics, and Surgery conferences. Ianthe is currently Chief Investigator of two active randomised controlled trials (ICEAGE and NIPPER PLUS) and leading CHESTY (Chest infection prevalence after surgery). CHESTY will be one of the largest international collaborative trials in Cardiorespiratory Physiotherapy and will involve over 50 hospitals world-wide.

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