Intensive physical therapy after emergency laparotomy: pilot phase of incidence of complications following emergency abdominal surgery get exercising randomized controlled trial

Background

Postoperative pneumonia and delayed physical recovery are significant problems after emergency laparotomy. No randomized controlled trial has assessed the feasibility, safety, or effectiveness of intensive postoperative physical therapy in this high-risk acute population.

Methods

The internal pilot phase of the Incidence of Complications after Emergency Abdominal surgery Get Exercising (ICEAGE) trial was a prospective, randomized controlled trial that evaluated the feasibility, safety, and clinical trial processes, of providing intensive physical therapy immediately following emergency laparotomy. Fifty consecutive patients were recruited at the principal participating hospital and randomly assigned to standard-care or intensive physical therapy of twice daily coached breathing exercises for two days and 30-minutes of daily supervised rehabilitation over the first five postoperative days.

Results

Interventions were provided exactly as per-protocol in 35% (78/221) of planned treatment sessions. Main barriers to protocol delivery were physical therapist unavailability on weekends (59/221 (27%)), awaiting patient consent (18/99 (18%)), and patient fatigue (26/221 (12%)). Despite inhibitors to treatment delivery, the intervention group still received twice as many breathing exercise sessions and four-times the amount of physical therapy over the first five postoperative days (23 minutes (IQR 12 – 29) v 86 minutes (IQR 53 – 121), p < 0.001). One adverse event was reported from 78 rehabilitation sessions (1.3%) which resolved fully on cessation of activity without escalation of medical care.

Conclusions

Intensive postoperative physical therapy can be delivered safely and successfully to patients in the first week after emergency laparotomy. The ICEAGE trial protocol resulted in intervention group participants receiving more coached breathing exercises and spending significantly more time physically active over the first five days after surgery compared to standard care. It was therefore recommended to progress into the multicentre phase of ICEAGE to definitively test the effect of intensive physical therapy to prevent pneumonia and improve physical recovery after emergency laparotomy.