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Chirurgia 2016 August;29(4):114-20


language: English

Enhanced abdominal wall rehabilitation after major surgery: a randomized controlled trial

Andrea GIANNINI 1, Gian Marco PALINI 2, Nicola FERRI 1, Luigi VENERONI 2

1 ArsManuum Rehabilitation, Rimini, Italy; 2 Infermi Hospital, Rimini, Italy


BACKGROUND: In the fast-track era, patients should be nursed in an environment that encourages independence and mobility. In this study we analyzed patients that underwent open abdominal surgery and consequently reported injury to the abdominal wall. Surgery, pain and hypomobility concur to reduce anterior abdominal wall trophism. An altered functionality of the anterior abdominal wall involves an altered functionality of patients.
METHODS: Fifty-two patients were selected randomly from March 2009 to February 2012. In accordance with the inclusion criteria, all patients included underwent midline incision on the alba line (xipho-umbilical or xipho-pubic). Oswestry Disability Index SF-36 score, VAS score and spirometric values were collected. The physical treatment proposed was composed of 10 physiotherapy sessions, twice a week for 6 weeks.
RESULTS: The domain “physical pain” into the study between groups is statistically significant, with a Ppre=0.0483 and a Ppost=0.0177; we hypothesize that the statistic and percent variation upon perceived pain (treatment group +61.9% vs. control group +1.61%) is to connect to the reactivation of abdominal wall function that has a positive effect to lumbar dynamics. Results of VAS scale for lumbar pain indicate a significant variation for the study intra groups (P treatment group 0.000, P control group 0.406) and for the study between groups (Ppre=0.1283, Ppost=0.0353); Oswestry Disability Index shows different variations in the two groups; as a matter of fact the studio intra groups records a significant variation between admission and discharge for the treatment group, with a P=0.0001. The study between groups (Ppost=0.0122) is included into significant parameters. Exercise may have beneficial effects at varying follow-up periods on health-related quality of life, especially physical functioning, role function, social functioning, and fatigue. Post-operative pulmonary complications are common in patients undergoing abdominal surgery and they are responsible for the increased morbidity and mortality as well as length of hospital stay and health related cost of care. Stability models acknowledge the importance of muscle function for spine stability. Injury to the pelvic and lower abdominal musculature puts women at increased risk for low-back pain later in life.
CONCLUSIONS: New trials with longer follow-up are necessary to discriminate an eventual long term overlapping of the groups. This may be complicated by the huge quantity of variables present, due to the too many different clinical conditions among patients without taking into consideration their surgical access. We need to underline the complexity to look for specific and reliable evaluation scores. It is evident, however, that the rehabilitation of the abdominal wall after a surgical trauma has a positive outcome on postoperative stay and on patients quality of life.

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