The Effect of Neurophysiological Facilitation Techniques on Health Parameters in Early Stages After Open Heart Surgery

The Effect of Neurophysiological Facilitation Techniques on Pulmonary Function, Respiratory Muscle Strength and Functional Capacity in The Early Stage After Open Heart Surgery

In this study, researchers aimed to investigate effects of neurophysiological facilitation on functional capacity and respiratory parameters of patients who underwent open heart surgery.

Do neurophysiological facilitation techniques improve individuals' respiratory parameters more than phase 1 cardiac rehabilitation?

Do neurophysiological facilitation techniques improve individuals' functional capacity more than phase 1 cardiac rehabilitation?

Researchers will apply phase 1 cardiac rehabilitation to both groups to see the effectiveness of neurophysiological facilitation techniques.

Study Overview

• Status: Recruiting
• Conditions: Cardiovascular Disease; Physiotherapy; Open Heart Surgery
• Intervention / Treatment: Procedure: Phase 1 cardiac rehabilitation; Procedure: Neurophysiological facilitation techniques

Detailed Description

In this study, researchers aimed to investigate effects of neurophysiological facilitation on functional capacity and respiratory parameters of patients who underwent open heart surgery.

The study was performed on 32 patients who underwent open heart surgery. Patients divided into two groups which study group (n=18) and control group (n=14).

Range of motion, breathing and mobilization exercises within the scope of phase 1 cardiac rehabilitation program were applied to the control group; in addition to the phase 1 cardiac rehabilitation program, neurophysiological facilitation techniques (perioral stimulation, intercostal tension, anterior basal lift, vertebral pressure, moderate manual pressure and abdominal co-contraction) were applied to the study group.

Sociodemographic features and disease-specific findings were recorded on the first postoperative day .

Vital signs, functional capacity, pulmonary function, fatigue and dyspnea of every patient were recorded before and after each treatment on the first four postoperative days.

Functional capacity was evaluated using Timed Up and Go (TUG) test and 2-Minutes Walking test (2MWT). Pulmonary function was examined using a peak flow meter and respiratory muscle strength was measured using an intraoral pressure measurement device. In addition, fatigue and dyspnea perception was measured using Modified Borg Scale.

Before the first day treatment and after the last day treatment of the four-day treatment, patients' fatigue severity were assessed with using Fatigue Severity Scale (FSS), anxiety and depression level with using Hospital Anxiety Depression Scale (HADS), fear of movement with using TAMPA Kinesiophobia Scale and life quality with using the Minnesota Heart Failure Questionnaire.

Before each treatment chest circumference measurements were taken, and the perceived pain severity was recorded using Visual Analog Scale (VAS).

• Study Type: Interventional
• Enrollment (Estimated): 32
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Feyza merakli; Phone Number: 0606 05427685223; Email: feyzamrkl@gmail.com
• Study Contact Backup: Name: Gungor

Study Locations

• Turkey
  • Ankara, Turkey, 06000
    • Recruiting
    • Lokman Hekim Akay Hospital
    • Contact: Physiotherapist; Phone Number: 05427685223
    • Principal Investigator: Feyza meraklı
    • Sub-Investigator: Yasemin Buran Çırak

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Having open heart surgery for the first time,
• Being between the ages of 18-75,
• Being fully cooperative

Exclusion Criteria:

• Having facial, sternum and rib fractures,
• Having chronic renal failure,
• Development of cerebrovascular accident,
• Having cognitive dysfunction,
• Development of deep vein thrombosis in the post-operative period,
• Having neuromuscular disease,
• Having an orthopedic disability,
• Intubation time longer than 24 hours,
• Staying in intensive care for more than 48 hours

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Control Group; Phase 1 cardiac rehabilitation	Procedure: Phase 1 cardiac rehabilitation; Day 1:Patients were informed about the surgery, positioning and mobilization.Range of motion (ROM), respiratory control, diaphragmatic breathing, pursed lip breathing, thoracal expansion exercises, assisted coughing,forced expiration techniques, which are the components of active breathing techniques cycle (ABTC), were taught.The use of incentive spirometry (IS) was demonstrated.Patients were performed 10 repetitions of IS exercises, and 5 repetitions ABTC and were asked to repeat them every hour.The patient was made to sit for 10 minutes and was walked 60 meters twice a day. 2:ROM, IS and diaphragmatic breathing exercises were applied 10 times each.ABTC was repeated in 5 sets. 120 meters was walked 5 times during the day. 3:Sitting time was increased to 30 minutes and walking distance was increased to 240 meters.5 steps were climbed. 4:Walking distance was increased to 360 meters.One flight of stairs was climbed.Discharge training was given.
Active Comparator: Study Group; Neurophysiological facilitation techniques in addition to phase 1 cardiac rehabilitation techniques	Procedure: Phase 1 cardiac rehabilitation; Day 1:Patients were informed about the surgery, positioning and mobilization.Range of motion (ROM), respiratory control, diaphragmatic breathing, pursed lip breathing, thoracal expansion exercises, assisted coughing,forced expiration techniques, which are the components of active breathing techniques cycle (ABTC), were taught.The use of incentive spirometry (IS) was demonstrated.Patients were performed 10 repetitions of IS exercises, and 5 repetitions ABTC and were asked to repeat them every hour.The patient was made to sit for 10 minutes and was walked 60 meters twice a day. 2:ROM, IS and diaphragmatic breathing exercises were applied 10 times each.ABTC was repeated in 5 sets. 120 meters was walked 5 times during the day. 3:Sitting time was increased to 30 minutes and walking distance was increased to 240 meters.5 steps were climbed. 4:Walking distance was increased to 360 meters.One flight of stairs was climbed.Discharge training was given.; Procedure: Neurophysiological facilitation techniques; In addition to the phase 1 cardiac rehabilitation program for the group receiving neurophysiological facilitation (NPF) techniques: NPF techniques such as perioral stimulation, intercostal tension, anterior basal lift, vertebral pressure, moderate manual pressure and abdominal co-contraction were applied for ten times for ten seconds. Diaphragm facilitation exercise was performed by inhaling against resistance and holding the breath against resistance for 5 seconds. Unilateral and bilateral upper extremity proprioceptive neuromuscular facilitation (PNF) movements combined with breathing were performed. NPF techniques were performed 10 times each day throughout the treatment, while other applications (diaphragm facilitation, combined breathing exercise with upper extremity PNF technique and respiratory facilitation) were performed 5 times on the first day and 10 times on the other three days.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
İnspiratory muscle strength	Maximum Inspiratory Pressure (MIP) - pressure	Before and after treatment on each day of treatment, up to 3 month
Expiratory muscle strength	Maximum Expiratory Pressure (MEP) - pressure	After and before treatment on each day of treatment, up to 3 month
2 Minute Walk Test	It is walking as fast as the person can for 2 minutes without any assistance, at a safe distance of 30 meters. - meter	Before treatment on the first day of treatment and after treatment on the last day of treatment, up to 3 month
Time Up and Go (TUG)	The person gets up from the chair, walks 3 meters, comes back and sits on the chair. - minute	first day of treatment before treatment and last day of treatment after treatment, up to 3 month
Vital sign	Oxygen saturation	Before and after treatment on each day of treatment, up to 3 month
Respiratory frequency	Number of times a person inhales and exhales in 1 minute. - number	Before and after treatment on each day, up to 3 month
Blood pressure	Blood pressure is the pressure of blood within the arteries of the circulatory system. - pressure	Before and after treatment on day of treatment, up to 3 month
Heart rate	Number of times a person heart rate in 1 minute. - number	Before and after treatment on each day of treatment, up to 3 month
Life quality	The Minnesota Living with Heart Failure Questionnaire	Before treatment on the first day of treatment and after treatment on the last day of treatment, up to 3 month
Depression	Beck's depression inventory	Before treatment on the first day of treatment and after treatment on last day of treatment, up to 3 month
Symptom	Dyspnea	Before and after treatment on each day of treatment, up to 3 month

Collaborators and Investigators

• Sponsor: Dogus Universitesi
• Investigators: Principal Investigator: Yasemin Cirak, Prof. Dr., Istinye University; Study Director: Feyza merakli, Istinye University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2024
• Primary Completion (Estimated): October 1, 2024
• Study Completion (Estimated): November 1, 2024

Study Registration Dates

• First Submitted: February 19, 2024
• First Submitted That Met QC Criteria: August 9, 2024
• First Posted (Actual): August 13, 2024

Study Record Updates

• Last Update Posted (Actual): August 13, 2024
• Last Update Submitted That Met QC Criteria: August 9, 2024
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Keywords: Cardiac rehabilitation; Neurophysiological facilitation technique
• Additional Relevant MeSH Terms: Cardiovascular Diseases
• Other Study ID Numbers: DogusU

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The study protocol, Informed Consent Form, Statistical Analysis Plan and Clinical Study Report will be shared upon request.
• IPD Sharing Time Frame: Data will remain open for 1 year.
• IPD Sharing Access Criteria: To be a journal in Science Citation Index (SCI), Emerging Sources Citation Index (ESCI) categories
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No