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Westerdahl, Elisabeth
Publications (10 of 13) Show all publications
Brocki, B. C., Westerdahl, E., Andreasen, J. & Andreasen, J. J. (2018). Can the Melbourne Scoring Scale be used to assess postoperative pulmonary complications in high-risk patients following lung resection?. Paper presented at 28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE. European Respiratory Journal, 52
Open this publication in new window or tab >>Can the Melbourne Scoring Scale be used to assess postoperative pulmonary complications in high-risk patients following lung resection?
2018 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2018
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-376321 (URN)10.1183/13993003.congress-2018.PA1423 (DOI)000455567101483 ()
Conference
28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE
Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2019-02-04Bibliographically approved
Brocki, B. C., Andreasen, J. J. & Westerdahl, E. (2018). Inspiratory Muscle Training in High-Risk Patients Following Lung Resection May Prevent a Postoperative Decline in Physical Activity Level. Integrative Cancer Therapies, 17(4), 1095-1102
Open this publication in new window or tab >>Inspiratory Muscle Training in High-Risk Patients Following Lung Resection May Prevent a Postoperative Decline in Physical Activity Level
2018 (English)In: Integrative Cancer Therapies, ISSN 1534-7354, E-ISSN 1552-695X, Vol. 17, no 4, p. 1095-1102Article in journal (Refereed) Published
Abstract [en]

Objectives. To describe postoperative self-reported physical activity (PA) level and assess the effects of 2 weeks of postoperative inspiratory muscle training (IMT) in patients at high risk for postoperative pulmonary complications following lung resection. Methods. This is a descriptive study reporting supplementary data from a randomized controlled trial that included 68 patients (mean age = 70 +/- 8 years), randomized to an intervention group (IG; n = 34) or a control group (CG; n = 34). The IG underwent 2 weeks of postoperative IMT added to a standard postoperative physiotherapy given to both groups. The standard physiotherapy consisted of breathing exercises, coughing techniques, and early mobilization. We evaluated self-reported physical activity (Physical Activity Scale 2.1 questionnaire) and health status (EuroQol EQ-5D-5L questionnaire), assessed the day before surgery and 2 weeks postoperatively. Results. A significant percentage of the patients in the IG reported less sedentary activity 2 weeks postoperatively when compared with the CG (sedentary 6% vs 22%, low activity 56% vs 66%, moderate activity 38% vs 12%, respectively; P = .006). The mean difference in EQ-5D-5L between the IG and CG 2 weeks postoperatively was nonsignificant (P = .80). The overall preoperative EQ-5D-5L index score for the study population was comparable to a reference population. Conclusion. Postoperative IMT seems to prevent a decline in PA level 2 weeks postoperatively in high-risk patients undergoing lung resection. More research is needed to confirm these findings.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS INC, 2018
Keywords
lung cancer, surgery, activity level, respiratory muscle training, postoperative, physiotherapy, randomized controlled trial
National Category
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-371036 (URN)10.1177/1534735418796286 (DOI)000450322400010 ()30136589 (PubMedID)
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-08Bibliographically approved
Urell, C., Emtner, M., Hedenström, H. & Westerdahl, E. (2016). Respiratory muscle strength is not decreased in patients undergoing cardiac surgery. Journal of Cardiothoracic Surgery, 11, Article ID 41.
Open this publication in new window or tab >>Respiratory muscle strength is not decreased in patients undergoing cardiac surgery
2016 (English)In: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 11, article id 41Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Postoperative pulmonary impairments are significant complications after cardiac surgery. Decreased respiratory muscle strength could be one reason for impaired lung function in the postoperative period. The primary aim of this study was to describe respiratory muscle strength before and two months after cardiac surgery. A secondary aim was to describe possible associations between respiratory muscle strength and lung function.

METHODS: In this prospective observational study 36 adult cardiac surgery patients (67 ± 10 years) were studied. Respiratory muscle strength and lung function were measured before and two months after surgery.

RESULTS: Pre- and postoperative respiratory muscle strength was in accordance with predicted values; MIP was 78 ± 24 cmH2O preoperatively and 73 ± 22 cmH2O at two months follow-up (p = 0.19). MEP was 122 ± 33 cmH2O preoperatively and 115 ± 38 cmH2O at two months follow-up (p = 0.18). Preoperative lung function was in accordance with predicted values, but was significantly decreased postoperatively. At two-months follow-up there was a moderate correlation between MIP and FEV1 (r = 0.43, p = 0.009).

CONCLUSIONS: Respiratory muscle strength was not impaired, either before or two months after cardiac surgery. The reason for postoperative lung function alteration is not yet known. Interventions aimed at restore an optimal postoperative lung function should focus on other interventions then respiratory muscle strength training.

Keywords
Cardiac surgery; Lung function; Median sternotomy; Respiratory muscle strength
National Category
Cardiac and Cardiovascular Systems
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-288399 (URN)10.1186/s13019-016-0433-z (DOI)000374540500001 ()27036318 (PubMedID)
Available from: 2016-04-27 Created: 2016-04-27 Last updated: 2017-11-30Bibliographically approved
Olsen, M. F., Carlsson, M., Olsen, E. & Westerdahl, E. (2015). Evaluation of Pressure Generated by Resistors From Different Positive Expiratory Pressure Devices. Respiratory care, 60(10), 1418-1423
Open this publication in new window or tab >>Evaluation of Pressure Generated by Resistors From Different Positive Expiratory Pressure Devices
2015 (English)In: Respiratory care, ISSN 0020-1324, E-ISSN 1943-3654, Vol. 60, no 10, p. 1418-1423Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Breathing exercises with positive expiratory pressure (PEP) are used to improve pulmonary function and airway clearance. Different PEP devices are available, but there have been no studies that describe the pressure generated by different resistors. The purpose of this study was to compare pressures generated from the proprietary resistor components of 4 commercial flow-dependent PEP valves with all other parameters kept constant. METHODS: Resistors from 4 flow-regulated PEP devices (Pep/Rmt system, Wellspect HealthCare; Pipe P breathing exerciser, Koo Medical Equipment; Mini-PEP, Philips Respironics [including resistors by Rusch]; and 15-mm endo-adapter, VBM Medizintechnik) were tested randomly by a blinded tester at constant flows of 10 and 18 L/min from an external gas system. All resistors were tested 3 times. RESULTS: Resistors with a similar diameter produced statistically significant different pressures at the same flow. The differences were smaller when the flow was 10 L/min compared with 18 L/min. The differences were also smaller when the diameter of the resistor was increased. The pressures produced by the 4 resistors of the same size were all significantly different when measuring 1.5- and 2.0-mm resistors at a flow of 10 L/min and 2.0-mm resistors at a flow of 18 L/min (P < .001). There were no significant differences between any of the resistors when testing sizes of 4.5 and 5.0 mm at either flow. The Mini-PEP and adapter resistors gave the highest pressures. CONCLUSIONS: Pressures generated by the different proprietary resistor components of 4 commercial PEP devices were not comparable, even though the diameter of the resistors is reported to be the same. The pressures generated were significantly different, particularly when using small-diameter resistors at a high flow. Therefore, the resistors may not be interchangeable. This is important information for clinicians, particularly when considering PEP for patients who do not tolerate higher pressures.

Keywords
positive expiratory pressure, breathing exercises, resistance breathing
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-265696 (URN)10.4187/respcare.03587 (DOI)000362268600011 ()
Available from: 2015-11-03 Created: 2015-11-02 Last updated: 2017-12-01Bibliographically approved
Olsen, M. F., Lannefors, L. & Westerdahl, E. (2015). Positive expiratory pressure - Common clinical applications and physiological effects. Respiratory Medicine, 109(3), 297-307
Open this publication in new window or tab >>Positive expiratory pressure - Common clinical applications and physiological effects
2015 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 109, no 3, p. 297-307Article, review/survey (Refereed) Published
Abstract [en]

Breathing out against resistance, in order to achieve positive expiratory pressure (PEP), is applied by many patient groups. Pursed lips breathing and a variety of devices can be used to create the resistance giving the increased expiratory pressure. Effects on pulmonary outcomes have been discussed in several publications, but the expected underlying physiology of the effect is seldom discussed. The aim of this article is to describe the purpose, performance, clinical application and underlying physiology of PEP when it is used to increase lung volumes, decrease hyperinflation or improve airway clearance. In clinical practice, the instruction how to use an expiratory resistance is of major importance since it varies. Different breathing patterns during PEP increase or reduce expiratory flow, result in movement of EPP centrally or peripherally and can increase or decrease lung volume. It is therefore necessary to give the right instructions to obtain the desired effects. As the different PEP techniques are being used by diverse patient groups it is not possible to give standard instructions. Based on the information given in this article the instructions have to be adjusted to give the optimal effect. There is no consensus regarding optimal treatment frequency and number of cycles included in each treatment session and must also be individualized. In future research, more precise descriptions are needed about physiological aims and specific instructions of how the treatments have been performed to assure as good treatment quality as possible and to be able to evaluate and compare treatment effects.

Keywords
Breathing exercises, Physiology, Positive expiratory pressure
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-252400 (URN)10.1016/j.rmed.2014.11.003 (DOI)000351647000002 ()
Available from: 2015-05-06 Created: 2015-05-06 Last updated: 2017-12-04Bibliographically approved
Westerdahl, E., Urell, C., Jonsson, M., Bryngelsson, I.-L., Hedenström, H. & Emtner, M. (2014). Deep Breathing Exercises Performed 2 Months Following Cardiac Surgery: A Randomized Controlled Trial. JOURNAL OF CARDIOPULMONARY REHABILITATION AND PREVENTION, 34(1), 34-42
Open this publication in new window or tab >>Deep Breathing Exercises Performed 2 Months Following Cardiac Surgery: A Randomized Controlled Trial
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2014 (English)In: JOURNAL OF CARDIOPULMONARY REHABILITATION AND PREVENTION, ISSN 1932-7501, Vol. 34, no 1, p. 34-42Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Postoperative breathing exercises are recommended to cardiac surgery patients. Instructions concerning how long patients should continue exercises after discharge vary, and the significance of treatment needs to be determined. Our aim was to assess the effects of home-based deep breathing exercises performed with a positive expiratory pressure device for 2 months following cardiac surgery. METHODS: The study design was a prospective, single-blinded, parallel-group, randomized trial. Patients performing breathing exercises 2 months after cardiac surgery (n = 159) were compared with a control group (n = 154) performing no breathing exercises after discharge. The intervention consisted of 30 slow deep breaths performed with a positive expiratory pressure device (10-15 cm H2O), 5 times a day, during the first 2 months after surgery. The outcomes were lung function measurements, oxygen saturation, thoracic excursion mobility, subjective perception of breathing and pain, patient-perceived quality of recovery (40-Item Quality of Recovery score), health-related quality of life (36-Item Short Form Health Survey), and self-reported respiratory tract infection/pneumonia and antibiotic treatment. RESULTS: Two months postoperatively, the patients had significantly reduced lung function, with a mean decrease in forced expiratory volume in 1 second to 93 +/- 12% (P< .001) of preoperative values. Oxygenation had returned to preoperative values, and 5 of 8 aspects in the 36-Item Short Form Health Survey were improved compared with preoperative values (P< .01). There were no significant differences between the groups in any of the measured outcomes. CONCLUSION: No significant differences in lung function, subjective perceptions, or quality of life were found between patients performing home-based deep breathing exercises and control patients 2 months after cardiac surgery.

National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-190789 (URN)10.1097/HCR.0000000000000020 (DOI)000335569100005 ()
Available from: 2013-01-17 Created: 2013-01-08 Last updated: 2014-07-02Bibliographically approved
Johansson, H., Sjöholm, R., Stafberg, A. & Westerdahl, E. (2013). Breathing Exercises with Positive Expiratory Pressure after Abdominal Surgery The Current Phys: The Current Physical Therapy Practice in Sweden. Journal of Anesthesia & Clinical Research, 4(6), Article ID 1000325.
Open this publication in new window or tab >>Breathing Exercises with Positive Expiratory Pressure after Abdominal Surgery The Current Phys: The Current Physical Therapy Practice in Sweden
2013 (English)In: Journal of Anesthesia & Clinical Research, ISSN 2155-6148, E-ISSN 2155-6148, Vol. 4, no 6, article id 1000325Article in journal (Refereed) Published
Abstract [en]

Objectives: In Sweden breathing exercises with Positive Expiratory Pressure (PEP) are commonly recommended for the prevention of pulmonary complications after abdominal surgery. Scientific documentation of the effects of PEP treatment is limited. The aim of this national survey was to describe the current physical therapy practice of PEP treatment after abdominal surgery in Sweden. Methods: A questionnaire was sent by e-mail to the 45 physical therapists who work with abdominal surgery patients in all seven university hospitals in Sweden. The questionnaire contained questions about the usage of PEP after abdominal surgery. Results: In total, 24 (54%) of the physical therapists answered the questionnaire. All reported using PEP as a treatment option after abdominal surgery. The most commonly used PEP device was the Blow bottle system and the PEP ventil system connected to a mouthpiece. Recommendations regarding treatment frequency and implementation varied significantly across respondents. The number of breaths per treatment varied considerably. Conclusion: All respondentsreported using PEP as a postoperative treatment on abdominal surgery wards. The treatment is most often recommended hourly during the first postoperative days. The common first-choice PEP devices were the Blow bottle system, Pep/Rmt set with mouthpiece or mask, Breathing exerciser/PEP valve system 22, and the Mini-PEP.

National Category
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-253739 (URN)10.4172/2155-6148.1000325 (DOI)
Available from: 2015-06-02 Created: 2015-06-02 Last updated: 2017-12-04Bibliographically approved
Urell, C., Westerdahl, E., Hedenström, H., Janson, C. & Emtner, M. (2012). Lung Function Before and Two Days After Open-Heart Surgery. Critical Care Research and Practice, Article ID:-291628
Open this publication in new window or tab >>Lung Function Before and Two Days After Open-Heart Surgery
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2012 (English)In: Critical Care Research and Practice, ISSN 2090-1313, p. Article ID:-291628Article in journal (Refereed) Published
Abstract [en]

Reduced lung volumes and atelectasis are common after open-heart surgery, and pronounced restrictive lung volume impairmenthas been found. The aim of this study was to investigate factors influencing lung volumes on the second postoperative day. Open-heart surgery patients (n = 107, 68 yrs, 80% male) performed spirometry both before surgery and on the second postoperative day. The factors influencing postoperative lung volumes and decrease in lung volumes were investigated with univariate and multivariate analyses. Associations between pain (measured by numeric rating scale) and decrease in postoperative lung volumes were calculated with Spearman rank correlation test. Lung volumes decreased by 50% and were less than 40% of the predictive values postoperatively. Patients with BMI > 25 had lower postoperative inspiratory capacity (IC) (33% ± 14% pred.) than normalweight patients (39% ± 15% pred.), (P = 0.04).More pain during mobilisation was associated with higher decreases in postoperative lung volumes (VC: r = 0.33, P = 0.001; FEV1: r = 0.35, P ≤ 0.0001; IC: r = 0.25, P = 0.01). Patients with high BMI are a risk group for decreased postoperative lung volumes and should therefore receive extra attention during postoperative care. As pain is related to a larger decrease in postoperative lung volumes, optimal pain relief for the patients should be identified.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-187856 (URN)10.1155/2012/291628 (DOI)
Available from: 2012-12-11 Created: 2012-12-11 Last updated: 2013-02-14Bibliographically approved
Antonsson, M., Fagevik Olsén, M., Johansson, H., Sandström, L., Urell, C., Westerdahl, E. & Wiklund, M. (2011). Lungefysioterapi ved abdominal- og thoraxkirurgi. Fysioterapeuten, 9
Open this publication in new window or tab >>Lungefysioterapi ved abdominal- og thoraxkirurgi
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2011 (Danish)In: Fysioterapeuten, Vol. 9Article in journal (Other academic) Published
Abstract [da]

I snart hundrede år har fysioterapeuter arbejdet på at mindske risikoen for postoperative lungekomplikationer hos patienter, der skal opereres i brystkassen og abdominalregionen. Klinisk erfaring viser, at lungefysioterapi er vigtig, men hvad ved vi i dag om effekten af forskellige former for behandling? Hvilke indsatsområder skal man i første omgang vælge? Forfatterne til denne artikel har udarbejdet retningslinjer for lungefysioterapi til patienter, som gennemgår abdominal- og thoraxkirurgi. Målet med arbejdet med retningslinjerne har været at udrede og sammensætte eksisterende evidens for lungefysioterapeutiske behandlingsmetoder i forbindelse med abdominal- og thoraxkirurgiske indgreb.

Den samlede evidens i kombination med ekspertgruppens kommentarer har ført til anbefalinger for den kliniske behandling. Disse anbefalinger er målrettet fysioterapeuter i den kliniske praksis, som arbejder med abdominal - og thoraxkirurgiske patienter. Sigtet er, at den aktuelle og systematisk indsamlede viden vil bidrage til diskussioner på de forskellige arbejdspladser, og at anbefalingerne for behandling vil blive tilpasset de lokale forhold. Denne artikel sammenfatter retningslinjerne, som er publiceret på fysioterapiforbundets (Legitimerede Sjukgymnasters) hjemmeside under profession. De kliniske retningslinjer omfatter desuden en komplet referenceliste.

National Category
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-163495 (URN)
Available from: 2011-12-12 Created: 2011-12-12Bibliographically approved
Olsén, M. F., Lindstrand, H., Broberg, J. L. & Westerdahl, E. (2011). Measuring chest expansion: A study comparing two different instructions. Advances in Physiotherapy, 13(3), 128-132
Open this publication in new window or tab >>Measuring chest expansion: A study comparing two different instructions
2011 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 13, no 3, p. 128-132Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to examine and compare the effect of two alternative instructions when measuring chest expansion. In 100 healthy subjects, chest expansion was measured using a circumference tape. In 30 healthy subjects, chest expansion was measured by a Respiratory Movement Measuring Instrument (RMMI). Both measurements were made at the level of the fourth rib and the xiphoid process. The two instructions evaluated were the traditional one: “breathe in maximally” and “breathe out maximally”, which were compared with a new one “breathe in maximally and make yourself as big as possible” and “breathe out maximally and make yourself as small as possible”. The addition of “make yourself as big/small as possible” in the new instruction resulted in a significantly increased thoracic excusion, 1.4 cm in upper and 0.9 cm in lower level of thorax, measured by tape, compared with the traditional instruction (p < 0.001). Measurements obtained using the RMMI also showed a significant difference, 2.3 mm in upper and 4.1 mm in lower level of thorax, between the two instructions in favour of the new instruction (p < 0.05). The verbal instruction during measurement of chest expansion is of importance when measured by tape and RMMI. To assess the maximal range of motion in the chest, the patient should be instructed not only to “breathe in/out maximally”, but also instructed to “make yourself as big/small as possible”.

Keywords
Instruction, measuring, range of motion, RMMI, thorax
National Category
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-163493 (URN)10.3109/14038196.2011.604349 (DOI)
Available from: 2011-12-12 Created: 2011-12-12 Last updated: 2017-12-08Bibliographically approved
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