Table 2.

interventions provided in week 1

Sr. No.	Physiotherapy treatment goals	Therapeutic intervention	Treatment regimen
1.	To provide awareness of the condition, gain co-operation and consent of the patient and his family members	Patient and caregiver education and counselling about the exercise regimen and the importance of adherence to it	Patients and caregivers were educated about the importance of positioning every 2 hourly, early ambulation, and activity of daily living
2.	To prevent pulmonary, circulatory and integumentary complications post-surgery	Manual Positioning: half lying/semi-fowlers position was given initially; later upright sitting was given; air beds provided; ankle pumps	Positioning was given after every 2 hours: initially 10 reps x 1 set 2 times a day; later 10 reps x 2 sets 3-4 times a day
3.	To reduce pain at the incision site	pain control modality - TENS 4 electrodes were placed -2 above the umbilicus, 2 below para-medially	TENS therapy was administered for one minute at a stimulation level of 40-60 milliamperes
4.	To avoid strain over incision and suture site	Abdominal binders	Binder support during movements
5.	To improve bed mobility and to prevent prolonged immobilization	Monitored in bed transitional training and bedside mobilization given with binder: from rolling to side-lying, sitting, supported standing, standing, and spot marching was given	1-3 days: rolling, side-lying; 4-8 days: sitting and supported standing; 9th day onwards: standing and spot marching
6.	To promote airway clearance	1) Manual chest percussion and vibrations; 2) manually assisted cough	1) For 1-3 days initially; 2) for 4-8 days
7.	To improve breathing patterns, reduce dyspnea and respiratory rate	Deep breathing exercises: 1) Diaphragmatic breathing; 2) 4-4-8 breathing; 3) segmental breathing	Initially 10 reps x 1 set 2 times a day; later 10 reps x 2 sets 3-4 times a day
8.	To improve lung volumes (IRV) and capacities (FRC)	1) Thoracic expansion exercises: shoulder in full flexion with deep inspiration and extension with expiration	Initially 10 reps x 1 set 2 times a day; later 10 reps x 2 sets 3-4 times a day.
		2) Incentive spirometry (initially): flow-oriented spirometer used. Visual Feedback through different balls representing 600,900 and 1200cc	Starting from third-day post-surgery; initially 2-3 times a day; later in every 2 hours of interval
9.	To maintain joint integrity and mobility and prevent joint stiffness	AROM exercises of upper and lower limbs bilaterally	Initially 10 reps x 1 set 2 times a day; later 10 reps x 2 sets 3-4 times a day
10.	To bring back to normal ADL's	Self-paced walking in 30 meters hallway	Begin on post-op day 4, initially, 5 min, progressing up to 15-20 min

TENS: transcutaneous electrical nerve stimulation; IRV: inspiratory reserve volume; FRC: functional residual capacity; AROM: active range of motion; ADL's: activities of daily living