Effect of incentive spirometry and inspiratory muscle training on the formation of the therapeutic alliance between physical therapists and cardiac surgery patients

Abstract

Purpose: to assess the impact of the additional respiratory physical therapy (PT) on the indicators of therapeutic alliance formation in terms of inpatient PT. Design: randomized controlled trial. Participants: The study involved 120 patients of both sexes, who were submitted to cardiac surgeries. All procedures were performed by sternotomy on cardiopulmonary bypass. The patients were randomly divided into control group (CG), incentive spirometry group (ISG) and inspiratory muscle training group (IMTG. Interventions: The groups received standardized PT (early mobilization; therapeutic exercises; coughing). Before surgery, the patients were briefly consulted by a physical therapist. The groups differed in respiratory therapy. ISG patients additionally performed respiratory exercises with a Tri-Ball breathing exerciser (at least three repetitions of 10 strong, full and rapid inhalations through the breathing exerciser at the sessions with a physical therapist, as well as received recommendations to perform 3 sets with 10 repetitions every hour). IMTG patients additionally performed respiratory exercises with Respironics Threshold IMT breathing exerciser and received explanations and recommendations like ISG patients. Main Outcome Measures: Therapeutic alliance was assessed with the help of Working Alliance Inventory questionnaire, SF Hatcher Client form in particular. Тhe questions were split into three domains: "goal items", "task items" and "bond items. The questionnaire was filled in on the 7 postoperative day. Results: Statistical analysis did not reveal any difference in "goal items" domain between the groups: CG – 17.5 (14.25; 19) points, ISG – 18 (15; 20) points, IMTG – 19 (15; 20) points (р=0.411). The results of "task items" domain did not confirm the advantages of any of the groups as well: CG – 17 (14; 18) points, ISG – 16 (15; 18) points, IMTG – 17 (14; 19) points (р=0.865). The similar result was obtained in "bond items" domain: CG – 16 (13.25; 18) points, ISG – 16 (13; 18.75) points, IMTG – 16.5 (13; 18) points (р=0.867). Statistically similar results were obtained in the total questionnaire score: CG – 51 (43; 54.75) points, ISG – 50.5 (43.25; 55) points, IMTG – 52 (42; 56) points (р=0.800). Conclusions: Comparison of therapeutic alliance indicators between the groups did not confirm the impact of additional respiratory PT on the results of the questionnaire items, domains and the total score, despite the fact that using breathing exercisers required setting up, adjusting and achieving goals and objectives specific for working with breathing exercisers, as well as additional cooperation of a physical therapist and a patient.