Abstract
BACKGROUND: Thoracotomy often causes respiratory muscle injury, reduced chest wall expansion, decreased lung volume, and limited shoulder range of motion (ROM). Respiratory muscle-stretching exercises (RMSE) have been proposed to enhance chest expansion and facilitate recovery. This aimed to compare the effects of RMSE combined with conventional physical therapy versus conventional therapy alone in patients undergoing elective thoracotomy. METHODS: A single-center randomized controlled trial was conducted at Songklanagarind Hospital, Thailand, between August 2013 and December 2019. Twenty-eight patients scheduled for elective thoracotomy were recruited, and 23 (mean age 47.1 ± 15.2 years; 18 males, 5 females) completed the trials. Participants were randomized to an intervention group (RMSE plus conventional therapy, n = 12) or a control group (conventional therapy only, n = 11). RMSE consisted of four stretching exercises performed twice daily for eight days. Primary outcomes were middle and lower chest expansion (MCE, LCE), slow vital capacity (SVC), and shoulder flexion and abduction ROM, assessed preoperatively, on postoperative day 2, and day 8. RESULTS: Both groups demonstrated significant within-group improvement between days 2 and 8. In the intervention group, MCE increased by 1.46 cm (95%CI: -2.5 to -0.87), LCE by 1.75 cm (95%CI: -2.42 to -1.08), SVC by 438 mL (95%CI: -761 to -115), shoulder flexion by 48.3°, and abduction by 38.8° (95%CI: -57.2 to -20.4). Similar improvements were observed in the control group: MCE 1.18 cm (95%CI: -1.76 to -0.61), LCE 1.27 cm (95%CI: -1.91 to -0.65), SVC 347 mL (95%CI: -690 to -4), shoulder flexion 35.4° (95%CI: -50.6 to -20.2), and abduction 35.7° (95%CI: -54.0 to -17.4). Between-group comparisons showed no significant differences for any outcome (all Group x Time, p-value > 0.05). CONCLUSIONS: Respiratory muscle-stretching exercise combined with conventional therapy facilitated significant recovery in chest wall mobility, lung volume, and shoulder motion after thoracotomy. However, these benefits were not significantly greater than those achieved with conventional therapy alone. Clinically, Respiratory muscle-stretching exercise is feasible, safe, and may be considered as an adjunct to standard care. TRIAL REGISTRATION: TCTR20140224004.