The effect of abdominal support on functional outcomes in patients following major abdominal surgery: a randomized controlled trial

Oren Cheifetz, S Deborah Lucy, Tom J Overend, Jean Crowe, Oren Cheifetz, S Deborah Lucy, Tom J Overend, Jean Crowe

Abstract

Purpose: Immobility and pain are modifiable risk factors for development of venous thromboembolism and pulmonary morbidity after major abdominal surgery (MAS). The purpose of this study was to investigate the effect of abdominal incision support with an elasticized abdominal binder on postoperative walk performance (mobility), perceived distress, pain, and pulmonary function in patients following MAS.

Methods: Seventy-five patients scheduled to undergo MAS via laparotomy were randomized to experimental (binder) or control (no binder) groups. Sixty (33 male, 27 female; mean age 58±14.9 years) completed the study. Preoperative measurements of 6-minute walk test (6MWT) distance, perceived distress, pain, and pulmonary function were repeated 1, 3, and 5 days after surgery.

Results: Surgery was associated with marked postoperative reductions (p<0.001) in walk distance (∼75-78%, day 3) and forced vital capacity (35%, all days) for both groups. Improved 6MWT distance by day 5 was greater (p<0.05) for patients wearing a binder (80%) than for the control group (48%). Pain and symptom-associated distress remained unchanged following surgery with binder usage, increasing significantly (p<0.05) only in the no binder group.

Conclusion: Elasticized abdominal binders provide a non-invasive intervention for enhancing recovery of walk performance, controlling pain and distress, and improving patients' experience following MAS.

Keywords: 6-minute walk test; Adapted Symptom Distress Scale; abdominal binder; abdominal surgery; pain.

Figures

Figure 1
Figure 1
Flow diagram of study participants. For study completers, reasons (n) are provided for incomplete data on each measurement day. POD=postoperative day; 6MWT=6-minute walk test.
Figure 2
Figure 2
Box plot distribution for the short-form McGill Pain Questionnaire, present pain intensity (PPI) before and after surgery: bold solid box line is median, top of box is upper quartile (QU 75%), bottom of box is lower quartile (QL 25%), and whiskers correspond to inner fences. Upper and lower inner fences are drawn to the “outermost” observed data points within one step (1.5×the interquartile (QU—QL) range) above QU 75% and below QL 25% respectively. Binder group medians: preoperative=1, POD 1=3, POD 3=2; no binder group medians: preoperative=1. §p<0.001 PODs 1, 3, 5 versus preoperative; **p<0.01 binder versus no binder

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