Università degli studi di Modena e Reggio Emilia

Background and aim. Several diseases may affect the thoraco-pulmonary system. In most cases resection surgery represents the elective therapy. To date, consensus is still lacking on the efficacy of post-surgery rehabilitation (PR) in these patients. Aim of our study was, therefore, to evaluate the effectiveness of a PR in patients undergoing thoraco-polmonary resection surgery. Patients and measurements. Forty patients referred for PR "Villa Pineta" Hospital-Rehabilitation Centre (in the period January 2006 to December 2007) after thoraco-pulmonary resection surgery were studied; 24 out of them had been directly transferred from the Surgery Unit (Early Rehabilitation), while other 16 came from their home with surgery having taken place at least 15 days before (Late Rehabilitation). The following outcome measures were recorded at baseline and at the end of PR: respiratory muscle performance (MIP and MEP), arterial blood gases (ABG - PaO2, PaCO2, pH, SatO2, PaO2/FiO2), the distance walked at the 6 minute test (6MWD) with related symptoms (dispnoea and muscle fatigue), scale of chronic dispnoea (MRC), questionnaire of perceived quality of life (SGRQ). Results. After PR, significant improvements (p <0.05) related to MIP-MEP, 6MWD with symptoms, MRC and SGRQ have been recorded in both subgroups. Only patients in the Early Rehabilitation group also showed improvements of blood oxygenation (PaO2, SatO2, PaO2/FiO2). Univariate analysis performed among groups in all the outcomes taking number and percentage of patients improved (as assessed by a pre-defined cut-off), has shown that both dyspnea (p =0.014) and muscle fatigue (p = 0.046) significantly differ in favour of the Early rehabilitation group. Conclusions. Our study suggests that rehabilitation may produce clinically relevant improvements in patients recovering from thoraco-pulmonary resection surgery. Effectiveness is more likely to be higher if program is applied early after surgery.

Pulmonary rehabilitation is a multidisciplinary non-pharmacological therapy delivered to patients with disability following respiratory chronic disorders or even post-acute respiratory consequences. The present description reports a case of rehabilitation process applied to a patient following cardio-surgery with respiratory insufficiency as a major complication. This case report shows an example of the professional integration and of the sharing process of rehabilitation. This is individually tailored and aimed at improving the patient's individual abilities and perceived quality of life.

Aim. To assess the sk-minute walk test (6 MWT) with and without encouragement in patients with severe chronic obstructive pulmonary disease (COPD). Methods. Thirty-eight COPD patients (72 ± 6 years, FEV 37 ± 12% pred.) performed 6 MWT in random order in two non consecutive days. The first test was carried out including encouragement according to the ATS standard procedure (WTE), the second without any phrase of encouragement (WTNE). Subgroup analysis has been also performed by dividing patients on the basis of their own level of exercise tolerance at the baseline test (6 MWT < 300 and > 300 meters). The measured variables included the total distance covered (M), subjective dyspnoea (D) and leg fatigue (F) as assessed by Borg scale, the main cardio-respiratory parameters as recorded along the test. Results. M was significantly higher during WTE than during WTNE (370 ± 78 and 336 ± 79 meters, respectively), whereas D and F only showed a non significant trend to increase during WTE. No significant differences of the other physiological parameters have been recorded between the two tests. Results similar to those obtained in the whole group have also been observed in both pre-defined subgroups of patients. Conclusions. Our study has shown that the encouraged recommended modality of 6 MWT is associated to a better result in terms of walked distance as compared with the non encouraged test in severe COPD patients. This was not associated with a detrimental effect on the cardiopulmonary responses.