The effect of digital physiotherapy applications on respiratory functions, respiratory muscle strength, functional capacity, upper extremity peripheral muscle strength and quality of life in patients undergoing thoracic surgery

Thoracic surgery is the primary intervention for the treatment of lung, pleural, chest wall and mediastinal diseases, and changes in lung function and clinical symptoms occur after surgery, both procedure- and patient-related. After thoracic surgery, patients' exercise tolerance decreases, respiratory functions deteriorate, and their participation in activities of daily living, functional levels and quality of life are adversely affected. With open thoracotomy, depending on the size of the incision, muscle division and incisional pain, upper extremity functions and the trunk are affected. A review of the literature reveals the application of preoperative and early postoperative physiotherapy programmes in patients undergoing thoracic surgery. However, there is a paucity of studies examining the effectiveness of long-term physiotherapy after discharge, and the duration of treatment is often brief. One of the methods of delivering physiotherapy programmes to patients is digital physiotherapy. Digital physiotherapy is a contemporary term used for health services provided remotely through digital communication and devices. The present study aims to investigate the effects of digital physiotherapy on pulmonary function, respiratory muscle strength, functional capacity, upper extremity muscle strength and quality of life in patients undergoing thoracic surgery. Our study included 26 patients who underwent thoracic surgery with open thoracotomy at the Department of Thoracic Surgery, Bezmialem Vakif University Hospital, and who met our inclusion criteria. Patients were randomly divided into two groups as training and control groups. All patients underwent pulmonary function testing, respiratory muscle strength measurement, 6-minute walk test (6MWD), trunk lateral flexion assessment, shoulder flexion and abduction range of motion and muscle strength measurements, shoulder function assessment with Shoulder Pain and Disability Index (SPADI), chest expansion measurement, sleep and quality of life assessments. The control group received general education after discharge. The training group underwent exercise sessions twice a week for 12 weeks using digital tools. Patients in the training group were asked to take a daily 30-minute walk at least five times a week. At the conclusion of 12 weeks, all patients were re-evaluated. SPSS v.30 software was used for data analysis, with a significance level of p<0.05 accepted in all analyses. At the end of 12 weeks, the training group demonstrated statistically significant improvements in all respiratory function parameters except FEV1/FVC and FVC (lt), respiratory muscle strength values, 6 MWT distance, ISI score, SPADI score, all upper extremity parameters except left abduction ROM and right abduction muscle strength, right and left trunk lateral flexion values, axillary and xiphoid chest expansion measurement and St. George respiratory questionnaire total score (p<0.05). In the control group, statistically significant improvements were found in FVC (lt), FEV1 (lt) and FEV1(%) values, SPADI score, upper extremity right flexion and left abduction ROM values, while a statistically significant decrease was found in the subcostal chest expansion value (p<0.05). Furthermore, in the comparisons between the groups, the improvements in PEF of pulmonary function parameters, MEP of respiratory muscle strength parameters, left upper extremity flexion and abduction muscle strength, right and left trunk lateral flexion and whole chest expansion in the training group compared to the control group were statistically significant (p<0.05). As a result, clinical symptoms and problems of patients who have undergone thoracic surgery continue after discharge. It has been shown that a home-based digital physiotherapy program planned after discharge is an effective method in improving patients' respiratory functions, shoulder disability and quality of life, and provides improvement in the clinical condition of patients. For patients undergoing thoracic surgery, a home-based physiotherapy program using digital methods is much more effective than routine care. Keywords: Thoracic surgery, physiotherapy, digital physiotherapy, pulmonary function, functional capacity, upper extremity function, quality of life