Blewitt, Kyra Lee2025-10-212024Blewitt, Kyra Lee. (2024). The outcomes of adult patients recovering from major thoracic trauma who participated n a programme of myofascial release and active exercise therapy [Master`s dissertation, University of the Witwatersrand, Johannesburg]. WIReDSpace. https://hdl.handle.net/10539/47119https://hdl.handle.net/10539/47119A research report submitted in fulfillment of the requirements for the Master of Science in Physiotherapy, in the Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, 2024Background and Purpose: Thoracic trauma can result in decreased respiratory function and chronic pain which affects a person’s quality of life (QOL). Patients who have suffered thoracic trauma often require prolonged hospital care. Pain and immobilisation have deconditioning effects on patients such as loss of muscle strength and respiratory complications. There is a lack of research into how a post discharge physiotherapy intervention impacts chronic pain and QOL in South African patients recovering from thoracic trauma. The effect of manual myofascial release techniques applied to the intercostal muscles and diaphragm on pain levels, pulmonary function, exercise capacity, and QOL outcomes for those recovering from thoracic trauma are unknown. Active exercises of the thoracic cage help to improve the thoracic range of motion in patients recovering from thoracic trauma. The proposed interventions of myofascial release and active exercises and its effects on patient outcomes has not been investigated previously. The purpose of this study was to determine the outcomes of adult patients recovering from major thoracic trauma who participated in a programme of myofascial release and active exercise therapy after hospital discharge. Methods: A prospective, longitudinal, quasi-experimental repeated measures design with a consecutive sampling method was conducted on patients with thoracic trauma after discharge from the trauma ward at a private hospital in Johannesburg. Outcomes assessed prior to hospital discharge included the Euroqol 5D (EQ-5D) (pre-injury status and pre-discharge status) and the Brief Pain Index (BPI). Physiotherapy intervention commenced four weeks post discharge and consisted of heat therapy, myofascial release of the intercostal muscles and diaphragm, active cycle of breathing technique, incentive spirometry, and active thoracic cage range of motion (ROM) exercises. Participants received these interventions at four, eight and 12 weeks after discharge. Outcomes assessed at four weeks and 12 weeks after discharge included EQ-5D, BPI, International Physical Activity Questionnaire (IPAQ), Maximal Inspiratory Pressure (MIP), Peak Expiratory Flow Rate (PEFR), handgrip strength, and active thoracic ROM. At six months post discharge a telephonic follow up was made where the EQ- 5D, BPI and IPAQ were reassessed. The Statistical Programming for the Social Sciences Statistics Version 23 software package was used for data analysis. Continuous data were summarised as means and standard deviations and categorical data were summarised as numbers and percentages. Paired samples t-tests were used to assess changes in continuous data over time. Level of significance was set as p<0.05. Results: A total of 35 participants agreed to take part in this study and were assessed prior to hospital discharge. Of these participants, 27 (77.1%) were male and 8 (22.9%) were female. The mean age of participants was 49.3 (±15.4; range 24-89) years. Only 12 participants iv completed the study. Results obtained from the BPI showed that changes in worst pain, least pain, average pain and current pain experienced by participants were all statistically significant at one-to-three month and one-to-six-month intervals (p<0.05, respectively). The BPI assessed pain with general activity, normal work, sleep, and enjoyment of life which all showed statistically significant changes from one to three months and one to six months (p<0.05, respectively). The BPI assessment of mood and walking ability showed statistically significant changes at one to six months post discharge from hospital (p<0.05). The mean change in pain experienced as reported with the EQ-5D visual analogue scale (VAS) from one month to six months was statistically significant (p=0.023). The changes observed in thoracic rotation ROM to the left and right sides from one month to three months were statistically significant (p=0.001 (left) and p=0.004 (right), respectively). Changes observed in MIP and PEFR were statistically significant from one month to three months with p-values of 0.004 and <0.001 respectively. The changes in handgrip strength using a handheld dynamometer from one month to six months was statistically significant with p<0.001 for both the right and left hands. Results obtained for physical activity showed that at the six month follow up 83.3% (n=10) of participants fell in the high activity category compared to 50% (n=6) of participants at the one month follow up. Overall, participants’ QOL improved during the six months period as their scores increased in all five domains of the EQ-5D from one month post discharge until the six month follow up. Conclusion: Patients who sustained thoracic trauma showed a significant improvement in their level of pain, pulmonary function (MIP and PEFR), physical function (thoracic ROM and handgrip strength), and QOL from one month to six months post discharge after receiving a physiotherapy program consisting of myofascial release and active exercises. These findings need validation through further clinical trials.en© 2024 University of the Witwatersrand, Johannesburg. All rights reserved. The copyright in this work vests in the University of the Witwatersrand, Johannesburg. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of University of the Witwatersrand, Johannesburg.UCTDRib Fractures’‘RehabilitationThe outcomes of adult patients recovering from major thoracic trauma who participated n a programme of myofascial release and active exercise therapyDissertationUniversity of the Witwatersrand, JohannesburgSDG-3: Good health and well-being