Aim: We hypothesized that an enhanced physiotherapy care package of education, breathing exercises, and early rehabilitation would prevent respiratory complications and improve physical recovery after emergency laparotomy compared to standard care alone.

Design: ICEAGE was a prospective multicentre, parallel-group, double-blinded, active-placebo, randomised controlled trial powered for superiority.

Method: From 2016 to 2018, 288 consenting patients admitted for emergency laparotomy at three hospitals in Australia were randomised via concealed allocation to either “standard-care physiotherapy” (15-minutes daily ambulation and a single session of coached breathing exercises) or “enhanced-care physiotherapy” (30-minutes daily rehabilitation and twice daily coached breathing exercises). Primary outcome was a respiratory complication within 14 postoperative days.

Results: Compared to standard-care, enhanced-care physiotherapy halved respiratory complications; 27% v 13% (ARR 15% (95%CI 5 to 24%), NNT 7 (95%CI 4 to 19, p=0.002)) and referrals for sub-acute rehabilitation (20% v 8%, p=0.02). Participants receiving enhanced postoperative physiotherapy had a shorter hospital stay (13.4 days v 10.8 days, p=0.05) and reported better quality of life and physical function (WHODAS 30 (9) v 33 (10)) on hospital discharge and at 3-months post-surgery.

Key practice points: ICEAGE is the world’s first multicentre trial testing physiotherapy to improve outcomes following emergency laparotomy. Twice daily chest physiotherapy and 30-mins of daily exercise therapy delivered in the first seven postoperative days following emergency laparotomy prevented respiratory complications and improved physical function and quality of life up to three months after surgery. Further research is required to determine the dosage threshold for benefit and the cost-benefit of service implementation.


Boden I1,2,3, Sullivan K1,4, Hackett C2,5, Winzer B6, McKinnon M5, Robertson I3,7
1 Physiotherapy Department, Launceston General Hospital, Launceston, Tasmania, Australia
2 Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
3 College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
4 School of Primary Health Care, Faculty of Nursing, Medicine and Health Science, Monash University, Frankston, Victoria, Australia
5 Department of Physiotherapy, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
6 Physiotherapy Department, Northeast Health Wangaratta, Wangaratta, Victoria, Australia
7 Clifford Craig Foundation, Launceston General Hospital, Launceston, Tasmania, Australia

Ethics approval and trial registration: ACTRN 12615000318583. Registered 8 April 2015