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Table 1 Verification and rating of algorithm statements

From: Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence

  REVISED STEPS AFTER ROUND 1 n RATING ROUND 2 MEDIAN (SIQR) RATING ROUND 3 MEDIAN (SIQR)
COUGHING AND PROCEDURE ADOPTED TO FACILITATE COUGHING    
Teach pt to huff/cough with wound support 1. Teach patient to huff/cough with wound support. Use following strategies to facilitate procedure: deep breathing, PEP, high-pressure PEP and CPAP in combination with FET (or adjusted autogenic drainage). 5 2.0 (0.5) 1.0 (0.0)
If unsuccessful: suction patient through mouth piece 2. If all else fails include suctioning as a possible management strategy for removing secretions 5 2.0 (0.5) 2.0 (0.0)
  3. Use nebulization as a management option for the removal of secretions 5 3.0 (0.5) 3.0 (0.0)
Position pt in high sitting over the side of the bed 4. Position the patient in a stable, supported upright sitting position with a goal of positioning the patient out of bed to facilitate removal of secretions 5 1.0 (0.0) 1.0 (0.0)
CRITERIA FOR MOBILIZATION    
At rest pt is presenting stable blood pressure and heart rate with less than 8/10 rating on pain scale 5. Perform a clinical evaluation of pain level 5 3.0 (0.0) 3.0 (0.0)
At rest pt is presenting with no dyspnoea 6. At rest dyspnoea does not exceed 1 on MBS. 5 3.0 (0.5) 3.0 (0.0)
  7. Ensure sufficient pulmonary reserve (Oxygenation level PaO2:FiO2 > 40 kPa/300 mmHg) before initiating mobilization. 5 2.0 (1.5) 2.0 (0.0)
  8. Motor block assessment in patients receiving epidural analgesia 5 2.0 (0.5) 2.0 (0.0)
BREATHING TECHNIQUES    
Position pt in high sitting over the side of the bed/Long sitting in bed Incorporated into steps 4 and 16    
  9. Prescribe frequent breathing exercises-the goal is at least five maximum breaths every waking hour. 4 1.0 (0.25) 1.0 (0.0)
Use any of the following techniques based on pt performance: PEP mask; IPPB; PEEP Bottle; IS 10. Present breathing technique choice in the following hierarchy: DBE's followed by PEP mask or bottle; then IS and IPPB as the least likely choice. 4 2.0 (1.0) 2.0 (0.13)
  11. Deep breathing exercises (pursed lips breathing; inspiratory hold) are the first choice of breathing exercises with PaO2:FiO2 > 300 mmHg. 4 2.0 (0.88) 2.0 (0.0)
  12. In the presence of persistent post operative hypoxaemia (PaO2:FiO2 < 300 mmHg) initiate CPAP. 4 2.0 (0.63) 2.0 (0.0)
MOBILIZATION    
Pt must reach at least one of these goals with each treatment session: Sit out of bed; Walk 5 m; 15 m; 30 m with assistance; Walk 30 m without assistance. 13. Perform activities at dyspnoea intensity of 6 on the MBS. 5 1.0 (1.0) 1.0 (0.0)
Progression based on walking intensity of 6/10 on Borg Scale Incorporated into step 13    
Active dorsiflexion while in bed at least 20 times every waking hour 14. Active dorsiflexion while in bed at least 20 times every waking hour 5 4.0 (0.5) 4.0 (0.0)
Frequency: Days one and two (three times/day) 15. An intensive mobilization protocol that includes walking and stair climbing should be performed at least once daily with the goal of three times per day. 5 1.0 (0.5) 1.0 (0.0)
  16. Have patient sitting out of bed for a minimum of one hour twice daily AND walking at least 5 m as the goal on the first post operative day 5 1.0 (0.5) 1.0(0.0)
  1. CPAP: Continuous positive airway pressure; DBE: Deep breathing exercises; FET: Forced expiratory technique; FiO2: Fraction of inspired oxygen; IPPB: Intermittent positive pressure breathing; IS: Incentive spirometry; MBS: Modified Borg Scale; PEP: Positive expiratory pressure; pt: patient.