Structured Pulmonary Physiotherapy After Lung Cancer Surgery by Age Group

Age-Related Effects of a Structured Postoperative Pulmonary Physiotherapy Program After Lung Cancer Surgery: An Ambispective Observational Cohort Study in Middle-aged and Older Patients

This ambispective observational cohort study aims to evaluate age-related differences in clinical outcomes among patients undergoing lung cancer surgery who received a structured comprehensive in-patient physiotherapy (CIPT) program as part of standard postoperative care. The CIPT program includes patient education, chest physiotherapy, breathing exercises, airway clearance techniques, early mobilization, postural exercises, and upper- and lower-extremity range-of-motion exercises during the postoperative hospital stay.

The primary outcome is hospital length of stay. Secondary outcomes include clinical parameters (blood pressure, resting heart rate, oxygen saturation, and respiratory rate), symptom-related outcomes (dyspnea, fatigue, and incisional pain), and inflammatory biomarkers (C-reactive protein, neutrophil-to-lymphocyte ratio, and albumin). Outcomes are analyzed according to predefined age groups (45-64 years and 65-90 years) to evaluate potential age-related differences.

Study Overview

• Status: Completed
• Conditions: Lung Cancer; Postoperative Pulmonary Complications
• Intervention / Treatment: Behavioral: Comprehensive In-Patient Physiotherapy (CIPT) Program

Detailed Description

This ambispective observational cohort study evaluates age-related differences in clinical outcomes among patients undergoing lung cancer surgery who received a structured comprehensive in-patient physiotherapy (CIPT) program as part of standard postoperative care. Patients aged 45-90 years were included and classified into two predefined age groups: middle-aged (45-64 years) and older (65-90 years).

The CIPT program was initiated on the first day after transfer from the intensive care unit to the thoracic surgery ward and continued until hospital discharge. The program included patient education, breathing exercises, incentive spirometry, airway clearance techniques, early mobilization, postural exercises, and upper- and lower-extremity range-of-motion exercises. One session per day was supervised by a physiotherapist, with additional sessions performed independently by the patient or with caregiver assistance during hospitalization.

The primary outcome was hospital length of stay. Secondary outcomes included clinical parameters (blood pressure, resting heart rate, oxygen saturation, and respiratory rate), symptom-related outcomes (dyspnea, fatigue, and incisional pain), and inflammatory biomarkers (C-reactive protein [CRP], neutrophil-to-lymphocyte ratio [NLR], and albumin).

Outcomes were assessed during the postoperative inpatient period and compared between the predefined age groups. No randomization or non-intervention control group was included, as all participants received the same structured CIPT program as part of standard postoperative care.

• Study Type: Observational
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye)
    • Bezmialem Vakif University

Participation Criteria

Eligibility Criteria

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

• Sampling Method: Non-Probability Sample

Study Population

Adults aged 45-90 years who underwent lung cancer surgery at Bezmialem Vakif University Hospital and received routine comprehensive in-patient physiotherapy (CIPT) as part of standard postoperative care. Eligible participants were hemodynamically stable during the early postoperative period and were classified into middle-aged (45-64 years) and older (65-90 years) cohorts for comparative analysis.

Description

Inclusion Criteria:

• Patients aged 45 to 90 years
• Undergoing lung cancer surgery (lobectomy, segmentectomy, or pneumonectomy)
• Medically stable in the early postoperative period
• Able to participate in a structured pulmonary physiotherapy program
• Provided written informed consent

Exclusion Criteria:

• Hemodynamic instability preventing mobilization
• Severe cognitive impairment limiting cooperation
• Neurological or orthopedic conditions restricting mobilization
• Requirement for prolonged mechanical ventilation
• Presence of another active malignancy
• Any medical contraindication to physiotherapy as determined by the attending physician

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Middle-aged group (45-64 years); Participants aged 45-64 years who underwent lung cancer surgery and received the comprehensive in-patient physiotherapy (CIPT) program as part of standard postoperative care during hospitalization. Outcomes were assessed during the postoperative inpatient period and compared with those of the older cohort.	Behavioral: Comprehensive In-Patient Physiotherapy (CIPT) Program; The comprehensive in-patient physiotherapy (CIPT) program was provided as part of standard postoperative care following lung cancer surgery. The program included patient education, breathing exercises, incentive spirometry, airway clearance techniques, early mobilization, postural exercises, and upper- and lower-extremity range-of-motion exercises. It was initiated on the first day after transfer to the thoracic surgery ward and continued until hospital discharge. One session per day was supervised by a physiotherapist, with two additional sessions performed independently by the patient or with caregiver assistance
Older group (65-90 years); Participants aged 65-90 years who underwent lung cancer surgery and received the comprehensive in-patient physiotherapy (CIPT) program as part of standard postoperative care during hospitalization. Outcomes were assessed during the postoperative inpatient period and compared with those of the middle-aged cohort.	Behavioral: Comprehensive In-Patient Physiotherapy (CIPT) Program; The comprehensive in-patient physiotherapy (CIPT) program was provided as part of standard postoperative care following lung cancer surgery. The program included patient education, breathing exercises, incentive spirometry, airway clearance techniques, early mobilization, postural exercises, and upper- and lower-extremity range-of-motion exercises. It was initiated on the first day after transfer to the thoracic surgery ward and continued until hospital discharge. One session per day was supervised by a physiotherapist, with two additional sessions performed independently by the patient or with caregiver assistance

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Length of Hospital Stay	Length of hospital stay is defined as the number of days from postoperative admission to the ward until hospital discharge following lung cancer surgery.	Postoperative period, from ward admission after surgery until hospital discharge (maximum 30 postoperative days)
C-reactive protein (CRP)	Serum CRP levels (mg/L) will be measured to evaluate postoperative systemic inflammatory response.	Postoperative Day 1 and at hospital discharge (up to 30 days after surgery)
Peripheral Oxygen Saturation (SpO₂)	Peripheral oxygen saturation (%) will be measured using pulse oximetry to assess postoperative oxygenation status.	Postoperative Day 1 and at hospital discharge (up to 30 days after surgery)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neutrophil-to-Lymphocyte Ratio (NLR)	NLR will be calculated from complete blood count parameters to assess systemic inflammatory status.	Postoperative Day 1 and at hospital discharge (up to 30 days after surgery)
Serum Albumin	Serum albumin levels (g/dL) will be measured to assess nutritional status.	Postoperative Day 1 and at hospital discharge (up to 30 days after surgery)
Systolic Blood Pressure	Systolic blood pressure (mmHg) will be recorded to assess postoperative hemodynamic response.	Postoperative Day 1 and at hospital discharge (up to 30 days after surgery)
Diastolic Blood Pressure	Diastolic blood pressure (mmHg) will be recorded to assess postoperative hemodynamic response.	Postoperative Day 1 and at hospital discharge (up to 30 days after surgery)
Heart Rate	Heart rate (beats per minute) will be measured to evaluate cardiovascular response during the postoperative period.	Postoperative Day 1 and at hospital discharge (up to 30 days after surgery)
Dyspnea Severity	Dyspnea severity will be assessed using the Modified Borg Dyspnea Scale (0-10), where 0 indicates "no breathlessness" and 10 indicates "maximal breathlessness."	Postoperative Day 1 and at hospital discharge (up to 30 days after surgery)
Fatigue Severity	Fatigue will be assessed using the Borg Rating of Perceived Exertion (0-10), where higher scores indicate greater perceived fatigue.	Postoperative Day 1 and at hospital discharge (up to 30 days after surgery)
Incisional Pain Intensity	Incisional pain will be evaluated using the Numeric Rating Scale (NRS, 0-10), where 0 represents "no pain" and 10 represents "worst imaginable pain."	Postoperative Day 1 and at hospital discharge (up to 30 days after surgery)

Collaborators and Investigators

• Sponsor: Bezmialem Vakif University
• Investigators: Principal Investigator: Ayşe Sena Manzak Dursun, Assistant Professor, Bezmialem Vakif University

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2025
• Primary Completion (Actual): March 2, 2026
• Study Completion (Actual): March 2, 2026

Study Registration Dates

• First Submitted: February 17, 2026
• First Submitted That Met QC Criteria: February 24, 2026
• First Posted (Actual): March 2, 2026

Study Record Updates

• Last Update Posted (Actual): August 17, 2026
• Last Update Submitted That Met QC Criteria: August 14, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: lung cancer; pulmonary rehabilitation; thoracic surgery; early rehabilitation; lung cancer surgery; pulmonary physiotherapy; age-related outcomes
• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Respiratory Tract Diseases; Lung Diseases; Respiratory Tract Neoplasms; Thoracic Neoplasms; Lung Neoplasms
• Other Study ID Numbers: 2026/72

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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