Feasibility and Safety of Rhythmic Initiation-Based Neurophysiological Facilitation of Respiration Following Upper Abdominal Surgery: A Quasi-Experimental Study
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Abstract
Abstract
Background: Upper abdominal surgery commonly disrupts normal respiratory movement due to pain, reduced diaphragmatic excursion, and altered thoraco-abdominal coordination. In the early postoperative period, many patients struggle to perform volitional breathing exercises, limiting the effectiveness of conventional respiratory physiotherapy. Manual movement-based facilitation strategies, such as neurophysiological facilitation (NPF) using rhythmic initiation, may facilitate more coordinated breathing by providing graded tactile and proprioceptive input.
Objective: To evaluate the feasibility, safety, and immediate effects of rhythmic initiation–based neurophysiological facilitation of respiration on pain, oxygen saturation, respiratory rate, and breathing pattern in patients following upper abdominal surgery.
Methods: A single-group quasi-experimental study was conducted in 30 adults (18–60 years) who had undergone upper abdominal surgery. On postoperative day two, participants received a single session of rhythmic initiation–based NPF delivered by a physiotherapist. Pain was assessed using the Visual Analogue Scale (VAS), and oxygen saturation, respiratory rate, and breathing pattern were assessed using the Manual Assessment of Respiratory Motion (MARM). These measures were recorded immediately before and after the intervention. Feasibility and safety were evaluated by documenting adverse events. The trial was prospectively registered with the Clinical Trials Registry–India (CTRI/2024/05/067318).
Results: Significant changes were observed following the intervention. Mean pain scores decreased from 4.12 to 2.03 (p < 0.001), oxygen saturation increased from 94.67% to 96.80% (p < 0.001), and respiratory rate increased from 21.7 to 23.3 breaths/min (p < 0.001). Breathing pattern assessment demonstrated a significant shift toward more balanced thoraco-abdominal coordination (p = 0.030). No serious adverse events were reported; four participants (13.3%) experienced mild, transient discomfort during the intervention.
Conclusion: Rhythmic initiation-based neurophysiological facilitation of respiration appears to be a feasible and well-tolerated intervention during the early postoperative period following upper abdominal surgery. The intervention was associated with immediate changes in pain, oxygen saturation, respiratory rate, and breathing pattern. Larger controlled studies are warranted to determine its sustained effects and clinical effectiveness.
Keywords: Upper abdominal surgery; Rhythmic initiation; Neurophysiological facilitation; Breathing pattern; Postoperative physiotherapy
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