Abstract
Objective
To compare the postoperative outcomes of preoperative respiratory muscle training
(RMT) with a device to preoperative aerobic exercise training (AET) in patients undergoing
thoracic surgeries (cardiac and lung).
Data Sources
PubMed, EMBASE, Cochrane, and Web of Science were comprehensively searched upon inception
to 9/2020.
Study Selection
All randomized control studies, including preoperative RMT and preoperative AET compared
with a non-training control group, were included.
Data Extraction
The meta-analysis was performed for outcomes including postoperative pulmonary complications
(PPC), pneumonia, postoperative respiratory failure (PRF), hospital length of stay
(HLOS), and mortality. We performed a network meta-analysis based on Bayesian random-effects
regression models.
Data Synthesis
A total of 25 studies, 2070 patients were included in this meta-analysis. Pooled data
for the patients who performed RMT with a device showed a reduction in PPCs, pneumonia,
PRF with odds ratio (OR) of 0.35 (P value .006), 0.38 (P value .002), and 0.22 (P value .008), respectively. Pooled data for the patients who performed AET showed
reduction in PPC, pneumonia with a OR of 0.33 (P value <.00001) and OR of 0.54 (P value .01), respectively. HLOS was decreased by 1.69 days (P value <.00001) by performing RMT and 1.79 days (P value .0008) by performing AET compared with the usual group. No significant difference
in all-cause mortality compared with usual care in both RMT and AET intervention groups.
No significant difference in the incidence of PRF compared with usual group in RMT + AET
and AET alone intervention groups (OR 0.32; P=.21; OR 0.94; P=.87). Based on rank probability plots analysis, on network meta-analysis, RMT and
AET ranked similarly on the primary outcome of PPC and secondary outcomes of pneumonia,
PRF and HLOS.
Conclusions
In thoracic surgeries, preoperative RMT is comparable with preoperative AET to prevent
PPC, pneumonia, and PRF and reduce HLOS. It can be considered in patients in resource-limited
settings.
Keywords
List of abbreviations:
AET (aerobic exercise training), CI (confidence interval), HLOS (hospital length of stay), I2 (Heterogeneity), MD (mean difference), NMA (network meta-analysis), OR (odds ratio), PPC (postoperative pulmonary complications), PRF (postoperative respiratory failure), RMT (respiratory muscle training), SUCRA (surface under the cumulative ranking curve)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 17, 2022
Accepted:
October 26,
2022
Received in revised form:
September 14,
2022
Received:
April 3,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosures: none.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
