Activity restrictions after gynecological surgery: is there evidence? Nygaard IE, Hamad NM, Shaw JM. Int Urogynecol J (2013) 24:719-724.

B

eth Shelly PT, DPT, WCS, BCB PMD
6/5/13 Pelvic PT Distance Journal Club

Points made in general

·         controlled early resumption of activities promotes restoration of function
·         physical activities may be incorrectly blamed for post op failures (carrying is not causative to LBP)
·         prolonged bed rest causes complications

Wound healing

·         Collagen begins to appear in wound on day 2
·         Abdominal fascia (lab tests)

o   regains 51-80% of its strength at 6 weeks

o   regains 73-93% of its strength at 20 weeks

o    never achieves full pre-op strength

About the paper

·         tests done in the healthy population
·         IAP pressures vary greatly even with the same technique used
·         different techniques - rectal, intravesical, nasogastric
·         IAP during simple ADL and commonly restricted activities overlap considerable

 mean cmH2O

Bench press measured intravesical - 10.1 to 164.5

Bench press 26 pounds nasogastric 17.7, intravesical 164.5

 

Sit-ups measured intravesical 9.5 to 15.8

 Jumping measured nasogastric 74.8 to 177.4

 

Lift from ground heavy measured rectally 82 to 149.3 to 170

Lift from counter heavy (33 pounds according to one paper) measured rectally 54 to 92.5

 

Lift from ground light (5.5 pounds according to one paper) measured rectally 35.4 to 48 to 74.7

Lift from counter light  measured rectally 10 to 47.7

Discussion in the journal club points out

·         pre operative factors may affect post operative recovery and result in differences in suggestion activity restrictions - ie obesity.
·         exact mechanism of POP is not fully understood and that makes understanding the role of IAP post operatively difficult.

Multidisciplinary convalescence recommendations after gynecological surgery: a modified Delphi method among experts. Noordegraaf AV, et al.  BJOG (2011), published online Sept 7, 1557-1567.

		Lap hyst	Vag hyst	Abd hyst
Light activities	Lifting or carrying 11 pounds 2 hrs sustained sitting 30 min sustained standing or walking	1 wk	2 wk	2 wk
Moderate activities	Lifting of carrying 22 pounds Pushing or pulling 33 pounds Riding a bicycle Vacuum cleaning	2 wk	3 wk	3-4 wk
Heavy activities	Lifting or carrying 33 pounds Standing and walking during entire work day	3 wk	4 wk	6 wk
Resumption of (ave) job	8 hours per day 40 hours per week	3-4 wk	4 wk	6 wk

 

Postoperative activity restrictions any evidence? Weir LF, et al.  (2006) Obstet Gynecol 107:305-309.

Median cm H2O measured rectally

47.7 to 68.0

·         lift 8 pounds from counter, from low table, above head

·         lift 13 pounds from counter, from floor

·         touch floor, bend at waist, simulated gardening

·         lift 20 pounds from counter

·         crunch / sit up

70.0 to 83.3

·         Stand from chair - without hands, with hands on thighs

·         climbing stairs

·         touch the floor, bend at knees

·         walk on treadmill 2.2 mph, 2.7 mph, 3.3 mph

·         lift 8 pounds from floor

·         small cough sitting, standing

92.3 to 105.7

·         medium cough sitting, standing

·         supine to standing, standing to supine

·         lift 35 pounds from counter

122.5 to 149.3

·         lift from floor - 20 pounds, 35 pounds

·         jumping jacks

·         forceful cough standing, sitting