Authors (including presenting author) :
Lau YNN (1), Luk KYH (1), See KW (2), Poon TL (2), Chan HF (3), Cheung YF (3), Chan CMA (1)
Affiliation :
(1) Physiotherapy Department, Queen Elizabeth Hospital,
(2) Department of Neurosurgery, Queen Elizabeth Hospital,
(3) Department of Medicine, Queen Elizabeth Hospital
Introduction :
Deep brain stimulation (DBS) surgery optimizes functional outcomes in patients with Parkinson’s disease (PD) but poses high postoperative pulmonary risks due to their compromised respiratory function and medication cessation, worsening rigidity and dyskinesia. Preoperative physiotherapy has shown promising results in boosting the respiratory reserve of PD patients, thereby preventing adverse events. The Department of Neurosurgery (NS) and the Department of Medicine of the Queen Elizabeth Hospital (QEH) have referred PD patients for preoperative enhancement training.
Objectives :
The objective of this study was to evaluate the effect of preoperative physiotherapy on the pulmonary aspects of PD patients undergoing DBS surgery.
Methodology :
Patients with PD who underwent DBS surgery and completed out-patient preoperative cardiopulmonary physiotherapy training with evaluations conducted upon initial assessment before operation (T0), after physiotherapy training (T1) and one month after operation (T2) were evaluated.
Outcome measures included a spirometry test involving forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEFR), and FEV1/FVC ratio and distance covered during the six-minute walk test (6MWT). The incidence of chest infection postoperatively was manually retrieved from patients’ records.
Result & Outcome :
Four patients (mean age 65±6.8 years; modified Hoehn and Yahr (H&Y) scale 1.5-2.5) who completed three-month preoperative interventions were evaluated.
When comparing data of T0 with T1, mean FVC, FEV1, PEFR, and 6MWT distance increased by 13%, 12%, 6%, and 9% respectively. All patients demonstrated enhancement in FEV1/FVC ratio. These findings showed improved lung function after preoperative training.
Postoperatively, data were in decreasing trend when compared with T1, but most remained similar when compared with baseline (mean FVC -2%, mean FEV1 +2%, mean PEFR -3%, minimal variation in FEV1/FVC ratio in the four patients, and mean 6MWT distance -3%). No incident of chest infection was recorded. The results suggested that physiotherapy enhanced respiratory reserve and prevented postoperative pulmonary complications.
PD patients undergoing DBS surgery responded positively to preoperative physiotherapy interventions. This promising approach has the potential to boost patients’ respiratory function. Further research is warranted to explore training benefits.
