Abstracts of Higher Degree Dissertations

SUSAN M ALSHAGHANA MA MCSP

Course: Master of A r t s degree in Philosophy and Health Care, Un ivers i ty of S o u t h Wales, 1991

A full l i s t of Fel lowship a n d higher degree d isser ta t ions and theses is available f r o m Maureen Mu i r in t h e In fo rmat ion and Deve lopment Unit o f t h e CSP Educat ion Depar tment . Dissertat ions housed a t t h e CSP m a y b e v iewed by appo in tment . For access t o dissertat ions housed elsewhere, please con tac t t h e ins t i tu t ion concerned. (They are n o t normal ly available f o r loan.)

a mild-moderately handicapped child. They have been referred for physiotherapy but due to limited manpower they cannot both be treated maximally. Therefore, a fair allocation of therapy time IS

necessary. The established bio-ethical Drinciples of beneficence, non-

An Evaluation of Pre-operative Physiotherapy in the Prevention of Post-operative Respiratory Complications after Abdominal Surgery

DIANA E TYDEMAN MPhil MCSP

Course: Master o f Phi losophy degree, Universi ty o f East Angl ia. Housed at: Universi ty o f East Ang l ia Library

THE study reported upon in this thesis was designed to investigate the following five topics: 1. The value of pre-operative physiotherapy given to patients wi th normal lung function who are to undergo elective abdominal surgery.

2. The incidences of post-operative respiratory complications following elective abdominal surgery.

3. The value of simple spirometry as a pre-operative predictor of post-operative performance. 4. The value of pre-operative physiotherapy to patients with a history of cigarette smoking.

5. The value of pre-operative physiotherapy given to patients with pre-existing chest disease who are to undergo elective abdominal surgery.

A total of 185 patients admitted for elective abdominal surgery under general anaesthesia were studied. The overall incidence of post-operative respiratory complications was 18.9%. In 170 patients in whom pre-operative pulmonary function was normal, the incidence was 17.7%. In 15 patients who were judged pre- operatively to have abnormal pulmonary function the incidence was significantly higher at 33.3% (P < 0.03). Seven operative procedures were sampled and separate incidences for each procedure were also determined.

Increasing age, reduced pre-operative mobility, a long duration of inhalation anaesthesia, upper abdominal surgery and a vertical incision site, were all found to significantly influence post-operative

respiratory morbidity. This was also the case where there was a past or present history of cigarette smoking. Ex-smokers and current smokers showed similar complication rates of 22.6% and 22.8% respectively, compared to 12% in non-smokers.

Patients w i th normal pulmonary function were randomised into one of two groups at the outset of the study. Group A was composed of 84 patients who recieved both pre- and post-operative physiotherapy. Group B contained 8 6 patients who recieved only post-operative physiotherapy. The entry characteristics of both groups were similar. Pre-operative physiotherapy comprised one treatment consisting of:

0 An explanation of post-operative physiotherapy procedure and its aims.

0 The teaching of bi-lateral and uni-lateral lower thoracic expansion exercises and of breathing control.

0 Instruction in post-operative techniques to clear secretions from the lungs.

0 An explanation of the need for early post-operative mobilisation and the teaching of leg exercises.

The above regime was found to make little difference to post- operative progress.

Pre-operative forced vital capacity (FVC) and forced expiratdry volume in the first second (FEV,), as percentages of predicted normal values, produced significant negative correlations wi th the number of post-operative physiotherapy treatrnents given (P < 0.001).

The efficacy of the pre-operative physiotherapy regime studied remains unproven for patients wi th normal lung function, who are to undergo abdominal surgery.

The value of an intensive pre-operative programme of chest physiotherapy for patients with respiratory dysfunction could not be investigated because of the small number of eligible patients in the study.

Ethical Considerations Concerning the Selection of Handicapped Children for Physiotherapy Out-patient Treatment

Housed at: University College Library (philosophy) Swansea, S o u t h Wales

PHYSICALLY handicapped babies place a severe burden upon rehabilitation facilities and manpower, especially in countries where health care teams are not fully developed. Physiotherapists are frequently confronted with the need to make hard choices as to the allocation of their resources among a variety of potential recipients.

Throughout the work, t w o case histories are referred to, one

maleficence, autonomy and justice are referred to throughout the work, in order to select the most morally justifiable course of action. The specific role of a paediatric physiotherapist is described, taking into account the entitlements and obligations of the child, the health care professionals and society. In addition it becomes clear how the attitudes and values of the family can affect the child's outcome and consequently his quality of life.

Five options for the distribution of therapy time are compared, and as a result of careful ethical analysis, the morally most justifiable course of action is chosen.

810 Physiotherapy, December 1991, vol 77, no 12