Evidence Based Practice

Question 1

What evidence is there for breathing exercises in COPD?

Answer 1

Holland et al 2012
- Breathing exercises over 4-15 weeks improves functional exercise capacity in COPD patients compared to no intervention, but no consistent effects on dyspnoea or QOL

Question 2

What evidence is there for IMT?

Answer 2

Shoemaker et al 2009
- IMT appears to improve dyspnoea, walking test & QOL in COPD patients

Hill et al 2010
- Chronic COPD IMT prescription

Question 3

What evidence is there for pursed lipped breathing?

Answer 3

Bhatt 2012

- Acute increase in exercise capacity (6 min walk test) in stable COPD patients

Question 4

What evidence is there for PEP?

Answer 4

Johnston & James 2013

- Written survey, found regularly employed for people with cardiorespiratory conditions

Question 5

What evidence is there for the criteria for PPCs?

Answer 5

Scholes et al 2009

• Outlined 5 predictors for high risk of PPC
• Anaesthetic time, surgery type, respiratory co-morbidity, smoker, predicted VO2 max

Question 6

What evidence is there for mobilisation for abdominal surgery patients?

Answer 6

Mackay et al 2005
- addition of DB and coughing exercises to early mobilisation does not significantly reduce incidence of clinically significant PPCs

Haines et al 2013
- Patients 3 times more likely to develop PPCs for each day they did not mobilise away from bed

Question 7

What evidence is there for pre-op physio in cardiac surgery patients?

Answer 7

Snowden et al 2014
- Pre-op intervention (IMT, education, exercise and relaxation) reduces LOS in pts >63yo, risk of PPCs & time to extubation

Question 8

What evidence is there for deep breathing exercises in cardiac surgery patients?

Answer 8

Brasher et al 2013

• Addition of DB exercises does not significantly alter patient outcomes
• No significant difference in PPCs, LOS, oxyhaemoglobin saturation & pulmonary function

Question 9

What evidence is there for mobilisation for acutely ill patients?

Answer 9

Stiller & Phillips 2003 (lit review)

- Assess if the potential risks outweigh the benefits to establish when considering mobilisation

Question 10

What evidence is there for shoulder exercises post thoracotomy?

Answer 10

Reeve et al 2010

• No difference in PPCs & LOS
• For most patients early mobilisation is enough to prevent PPCs
• But also found exercise group had less total pain scores & better shoulder function at 1 & 3 months follow up