Acute Effects of Visual Feedback-Assisted Inspiratory Muscle Training After Lobectomy

Lung cancer is one of the leading causes of cancer-related mortality worldwide. In patients with early-stage non-small cell lung cancer, surgical resection remains the main curative treatment option. Lobectomy, particularly through video-assisted thoracic surgery, is commonly performed as an anatomical resection method. However, despite the advantages of minimally invasive thoracic surgery, patients may experience postoperative pulmonary complications, impaired respiratory muscle function, pain-related breathing limitations, and reduced exercise capacity after lobectomy.

Inspiratory muscle training is commonly used as part of postoperative physiotherapy and pulmonary rehabilitation after thoracic surgery. Because inspiratory muscle training requires active patient participation and effort, exercise motivation and adherence are important determinants of effective implementation. Recent technological developments have enabled the use of mobile application-supported systems and smart adaptors that provide visual feedback during inspiratory muscle training. Visual feedback may improve patient motivation, participation, and usability of the training. However, the acute effects of mobile application-supported inspiratory muscle training with visual feedback have not been adequately investigated in patients undergoing lobectomy after lung cancer surgery.

This study is designed to evaluate the acute effects of conventional inspiratory muscle training and visual feedback-assisted inspiratory muscle training on exercise motivation, dyspnea perception, usability, and patient satisfaction in lung cancer patients undergoing lobectomy via video-assisted thoracic surgery. The study will include clinically stable volunteers aged 18-75 years who are scheduled for lobectomy due to lung cancer and who are able to cooperate with the planned assessments. A total of 40 participants is planned.

Preoperative assessments will be performed on the day before surgery. Demographic and clinical characteristics, including age, height, body weight, smoking history, previous surgeries, and pulmonary function test results, will be recorded. Respiratory muscle strength will be assessed by measuring maximal inspiratory pressure and maximal expiratory pressure using a mouth pressure device.

The intervention will be performed on postoperative day 1 after the patient has been transferred to the ward. First, participants will perform conventional inspiratory muscle training without mobile application support or visual feedback in the morning. After at least two hours of rest, the same inspiratory muscle training protocol will be repeated with a smart adaptor connected to a mobile application, providing visual feedback during the exercise. Inspiratory muscle training will be performed using a threshold-loading device at 40% of maximal inspiratory pressure, with three sets of ten breaths during each session.

After each training session, exercise motivation, dyspnea perception, and patient satisfaction will be evaluated. Exercise motivation will be assessed using the Exercise Motivation Attitude Scale. Dyspnea perception will be assessed using the Modified Borg Scale before and after each intervention. Patient satisfaction, perceived difficulty of training, willingness to continue training, and perceived benefit will be evaluated using 0-10 rating scales. For the mobile application-assisted session, usability will also be assessed using the System Usability Scale. In addition, mobile application-derived data, including the number of successful breaths, total training duration, and total number of breaths, will be recorded.

The primary aim of the study is to determine whether visual feedback-assisted inspiratory muscle training provides more favorable acute effects on exercise motivation and patient adherence compared with conventional inspiratory muscle training. Secondary aims include evaluating dyspnea perception, usability of the mobile application-supported system, patient satisfaction, and objective training data obtained from the smart adaptor. The findings may contribute to the development of technology-supported pulmonary rehabilitation strategies after lobectomy and may guide the integration of visual feedback systems into routine postoperative respiratory physiotherapy.

Inclusion criteria

• Volunteering to participate in the study,
• Being clinically stable,
• Being a lung cancer patient scheduled for lobectomy,
• Being between 18 and 75 years of age,
• Being able to cooperate with the tests to be performed.

Exclusion criteria

• Presence of any orthopedic or neurological problem that prevents walking,
• History of any surgery involving the thoracic wall,
• Having diseases that may affect respiratory parameters, such as severe heart failure or severe chronic obstructive pulmonary disease (COPD).