A postoperative shoulder exercise program improves function and decreases pain following open thoracotomy: a randomised trial

Question: Does a postoperative physiotherapy exercise program incorporating shoulder exercises improve shoulder function, pain, range of motion, muscle strength, and health-related quality of life in patients undergoing elective pulmonary resection via open thoracotomy? Design: Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Participants: 76 patients who underwent pulmonary resection via open thoracotomy. Intervention: All participants received standard medical and nursing care involving a clinical pathway. The experimental group also received physiotherapy interventions that included daily supervised, progressive exercises until discharge and a postoperative exercise booklet on discharge. Outcome measures: Preoperatively and up to 3 months postoperatively pain was measured with a numerical rating scale, shoulder function with the Shoulder Pain and Disability Index, and quality of life with the Short Form-36. Shoulder range of motion and muscle strength were measured in a subgroup. Results: The experimental group had 1.3 units (95% CI 0.3 to 2.2) less shoulder pain (scored /10) and 2.2 units (95% CI 0.2 to 4.3) less total pain (scored /30) at discharge, and 7.6% (95% CI 1.7 to 13.6) better function at 3 months. The Short Form-36 physical component score was 4.8 points (95% CI -0.3 to 10.0) better for the experimental group than the control group at 3 months. Differences between groups in all range of motion and strength measures were small and statistically non-significant. Conclusion: A physiotherapist-directed postoperative exercise program resulted in significant benefits in pain and shoulder function over usual care for patients following open thoracotomy. Trial registration: ANZCTRN 12605000201673. [Reeve J, Stiller K, Nicol K, McPherson KM, Birch P, Gordon IR, Denehy L (2010) A postoperative shoulder exercise program improves function and decreases pain following open thoracotomy: a randomised trial. Journal of Physiotherapy 56: 245-252]