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  • 1. Antonsson, M.
    et al.
    Fagevik Olsén, M.
    Johansson, H.
    Sandström, L.
    Urell, C.
    Westerdahl, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Wiklund, M.
    Lungefysioterapi ved abdominal- og thoraxkirurgi2011In: Fysioterapeuten, Vol. 9Article in journal (Other academic)
    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.

  • 2.
    Brocki, Barbara Cristina
    et al.
    Aalborg Univ Hosp, Aalborg, Denmark.
    Andreasen, Jan Jesper
    Aalborg Univ Hosp, Aalborg, Denmark;Aalborg Univ, Aalborg, Denmark.
    Westerdahl, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Örebro Univ, Örebro, Sweden.
    Inspiratory Muscle Training in High-Risk Patients Following Lung Resection May Prevent a Postoperative Decline in Physical Activity Level2018In: Integrative Cancer Therapies, ISSN 1534-7354, E-ISSN 1552-695X, Vol. 17, no 4, p. 1095-1102Article in journal (Refereed)
    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.

  • 3.
    Brocki, Barbara Cristina
    et al.
    Aalborg Univ Hosp, Dept Occupat Therapy & Physiotherapy, Aalborg, Denmark.
    Westerdahl, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Orebro Univ, Fac Med & Hlth, Dept Physiotherapy, Orebro, Sweden.
    Andreasen, Jane
    Aalborg Univ Hosp, Dept Occupat Therapy & Physiotherapy, Aalborg, Denmark;Aalborg Univ, Publ Hlth & Epidemiol Grp, Dept Hlth Sci & Technol, Aalborg, Denmark.
    Andreasen, Jan Jesper
    Aalborg Univ Hosp, Dept Cardiothorac Surg, Aalborg, Denmark;Aalborg Univ, Dept Clin Med, Aalborg, Denmark.
    Can the Melbourne Scoring Scale be used to assess postoperative pulmonary complications in high-risk patients following lung resection?2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal (Other academic)
  • 4.
    Johansson, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Sjöholm, Rebecca
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Stafberg, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Westerdahl, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Breathing Exercises with Positive Expiratory Pressure after Abdominal Surgery The Current Phys: The Current Physical Therapy Practice in Sweden2013In: Journal of Anesthesia & Clinical Research, ISSN 2155-6148, E-ISSN 2155-6148, Vol. 4, no 6, article id 1000325Article in journal (Refereed)
    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.

  • 5.
    Olsen, Monika Fagevik
    et al.
    Gothenburg Univ, Dept Gastrosurg Res & Educ, Sahlgrenska Acad, Gothenburg, Sweden.;Gothenburg Univ, Dept Phys Therapy, Sahlgrenska Univ Hosp, Gothenburg, Sweden.;Gothenburg Univ, Sahlgrenska Acad, Gothenburg, Sweden..
    Carlsson, Maria
    Gothenburg Univ, Dept Phys Therapy, Sahlgrenska Univ Hosp, Gothenburg, Sweden.;Gothenburg Univ, Sahlgrenska Acad, Gothenburg, Sweden..
    Olsen, Erik
    Chalmers, S-41296 Gothenburg, Sweden..
    Westerdahl, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Evaluation of Pressure Generated by Resistors From Different Positive Expiratory Pressure Devices2015In: Respiratory care, ISSN 0020-1324, E-ISSN 1943-3654, Vol. 60, no 10, p. 1418-1423Article in journal (Refereed)
    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.

  • 6. Olsen, Monika Fagevik
    et al.
    Lannefors, Louise
    Westerdahl, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Positive expiratory pressure - Common clinical applications and physiological effects2015In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 109, no 3, p. 297-307Article, review/survey (Refereed)
    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.

  • 7. Olsén, Monika Fagevik
    et al.
    Lindstrand, Hilda
    Broberg, Jenny Lind
    Westerdahl, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Measuring chest expansion: A study comparing two different instructions2011In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 13, no 3, p. 128-132Article in journal (Refereed)
    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”.

  • 8.
    Urell, Charlotte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Hedenström, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Tenling, Arne
    Breidenskog, Marie
    Westerdahl, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Deep breathing exercises with positive expiratory pressure at a higher rate improve oxygenation in the early period after cardiac surgery: a randomised controlled trial2010In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 40, no 1, p. 162-167Article in journal (Refereed)
    Abstract [en]

    Objective: In addition to early mobilisation, a variety of breathing exercises are used to prevent postoperative pulmonary complications after cardiac surgery. The optimal duration of the treatment is not well evaluated. The aim of this study was to determine the effect of 30 versus 10 deep breaths hourly, while awake, with positive expiratory pressure on oxygenation and pulmonary function the first days after cardiac surgery.

    Methods: A total of 181 patients, undergoing cardiac surgery, were randomised into a treatment group, performing 30 deep breaths hourly the first postoperative days, or into a control group performing 10 deep breaths hourly. The main outcome measurement arterial blood gases and the secondary outcome pulmonary function, evaluated with spirometry, were determined on the second postoperative day.

    Results: Preoperatively, both study groups were similar in terms of age, SpO(2), forced expiratory volume in 1s and New York Heart Association classification. On the second postoperative day, arterial oxygen tension (PaO(2)) was 8.9±1.7kPa in the treatment group and 8.1±1.4kPa in the control group (p=0.004). Arterial oxygen saturation (SaO(2)) was 92.7±3.7% in the treatment group and 91.1±3.8% in the control group (p=0.016). There were no differences in measured lung function between the groups or in compliance to the breathing exercises. Compliance was 65% of possible breathing sessions.

    Conclusions: A significantly increased oxygenation was found in patients performing 30 deep breaths the first two postoperative days compared with control patients performing 10 deep breaths hourly. These results support the implementation of a higher rate of deep breathing exercises in the initial phase after cardiac surgery.

  • 9.
    Urell, Charlotte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Hedenström, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Westerdahl, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Respiratory muscle strength is not decreased in patients undergoing cardiac surgery2016In: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 11, article id 41Article in journal (Refereed)
    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.

  • 10.
    Urell, Charlotte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Westerdahl, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Hedenström, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Lung Function Before and Two Days After Open-Heart Surgery2012In: Critical Care Research and Practice, ISSN 2090-1313, p. Article ID:-291628Article in journal (Refereed)
    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.

  • 11.
    Westerdahl, Elisabeth
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Lindmark, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Almgren, Stig-Olof
    Tenling, Arne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Chest physiotherapy after coronary artery bypass graft surgery: a comparison of three different deep breathing techniques2001In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 33, no 2, p. 79-84Article in journal (Refereed)
  • 12.
    Westerdahl, Elisabeth
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Lindmark, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Bryngelsson, Ing-Liss
    Tenling, Arne
    Pulmonary function 4 months after coronary artery bypass graft surgery2003In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 97, no 4, p. 317-322Article in journal (Refereed)
  • 13.
    Westerdahl, Elisabeth
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Urell, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Jonsson, Marcus
    Örebro universitetssjukhus.
    Bryngelsson, Ing-Liss
    Örebro Universitet.
    Hedenström, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Deep Breathing Exercises Performed 2 Months Following Cardiac Surgery: A Randomized Controlled Trial2014In: JOURNAL OF CARDIOPULMONARY REHABILITATION AND PREVENTION, ISSN 1932-7501, Vol. 34, no 1, p. 34-42Article in journal (Refereed)
    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.

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