currently , complete surgical resection represents the only curative treatment for lung 
 cancer1 . however ,
the majority of lung 
 cancer survivors who undergo lung resection experience pulmonary complications ; one - third of 
 these patients report dyspnea , and one - fifth suffer from severely diminished pulmonary 
 function , including respiratory muscle weakness2 . pulmonary rehabilitation ( pr )
has been proposed as an adjunctive 
 therapy to decrease the risk of postoperative pulmonary complications3 .
however , patients may not be able to consistently engage in 
 pr , for personal or economic reasons ( e.g. , lacking the funds to travel to rehabilitation 
 centers)4 .
therefore , there is a need 
 for alternative methods , such as home - based pr , to maintain physical functioning in a more 
 economical manner5 .
few studies have addressed pr 
 education for caregivers , who typically facilitate home - based exercises during the 
 outpatient period .
this study evaluated the effects of caregiver education on pr ( i.e. , 
 respiratory muscle strength and dyspnea ) in lung cancer patients following lung 
 resection .
patients scheduled for lung resection at the department of thoracic surgery of a national 
 university hospital , between march 2013 and november 2013 , whose caregivers had not 
 previously received education pertaining to pr , were selected for the study .
a total of 50 
 patients agreed to participate following an explanation of the study procedure , and written 
 informed consent was obtained from all participants .
ethics approval was obtained from the 
 inje university faculty of health science human ethics committee .
the subjects were randomly 
 assigned to experimental ( n = 25 ) and control ( n = 25 ) 
 groups the day before surgery . of these ,
3 and 6 subjects dropped out of the experimental 
 and control groups , respectively , during the 4-week study period , due to violation of the 
 exclusion criteria .
therefore , the final experimental and control groups were comprised of 
 22 and 19 subjects , respectively .
the subjects mean age was 60.2210.89  years ; their mean 
 height was 163.01  8.77  cm , mean weight was 61.3911.35  kg , and average bmi was 23.013.34 . 

caregiver education on pr 
 included guidance pertaining to splinted coughing , airway clearance and breathing , and 
 stretching and strengthening exercises .
the control group received general advice from the 
 department of thoracic surgery ( once per week for 30 minutes ) pertaining to pain management , 
 postoperative care , use of an incentive spirometer and nebulizer , and mobilization of the 
 upper limbs and trunk . in the case of subjects who were not able to visit the hospital ,
respiratory muscle strength was assessed using a microrpm device ( micro medical ltd . , 

maximum expiratory pressure ( mep ) 
 were measured using the method described by black & hyatt6 , and these served as indices of inspiratory and expiratory muscle 
 strength .
dyspnea was evaluated using the modified borg scale , ranging between 0 ( no 
 dyspnea ) and 10 ( most severe dyspnea ) .
data pertaining to the general 
 characteristics of subjects are provided as means  se , with intergroup homogeneity assessed 
 using  and independent t - tests .
group differences in scores before the 
 experiment , and 2 weeks ( baseline ) and 6 weeks after surgery , were assessed using 
 repeated - measures analysis of variance .
mip , mep and modified borg scale values were more significantly improved in the 
 experimental group compared to the control group , but there were no group differences 
 ( p<0.05 , table 1table 1.comparison of respiratory muscle strength and dyspneamean sdcontrolexperimentalmip ( cmh2o)baseline62.521.463.818.24 weeks68.021.271.519.0*mep ( cmh2o)baseline62.4224.361.615.64 weeks66.532.571.216.8*mborgbaseline3.081.162.451.464 weeks2.631.611.771.40**p<0.05 ) .
refai et al.7 reported an association 
 between respiratory muscle weakness after lung resection and increased incidence of 
 pulmonary complications .
recovery of respiratory muscle function after surgery is important 
 because lung resection leads to impairments in these muscles .
nomori et al.8 reported a 4.3% increase in mip , and 6.4% 
 increase in mep , 212 weeks after surgery .
these data are consistent with our finding that 
 mip and mep increased between weeks 26 in the control ( 8% and 6% , respectively ) and 
 experimental ( 12% and 15% , respectively ) groups . however , these group differences were not 
 significant .
previous studies demonstrated that smaller lung resection areas are associated 
 with greater differences in respiratory muscle strength before and after surgery8 , 9 .
we 
 speculate that respiratory muscle strength did not differ significantly among our groups 
 because all subjects had undergone video - assisted thoracoscopic surgery , which requires a 
 minimal incision in the respiratory muscles interacting with the chest wall .
dyspnea caused 
 by lung resection is an important determinant of patients quality of life10 .
our study commenced 2 weeks after the 
 surgery ; the experimental group was characterized by a decrease in dyspnea over time , but 
 this decrease was not significant compared to the control group .
differences between our 
 results and those of this previous study may be due to the use of indirect and direct 
 interventions , respectively . in conclusion , our data suggest that caregiver education on pr 
 can improve respiratory muscle strength and dyspnea .
 [ purpose ] this study evaluated the effects of caregiver education on pulmonary 
 rehabilitation of patients who have undergone lung resection for cancer . [ subjects ] 
 patients were divided into experimental ( n = 22 ) and control 
 ( n = 19 ) groups . 
 [ methods ] the caregivers of the experimental group 
 patients received education on pulmonary rehabilitation , while the control group patients 
 received general management advice for 4 weeks . [ results ] pulmonary muscle strength 
 ( maximum inspiratory pressure and maximum expiratory pressure ) was increased significantly 
 in the experimental group compared to the control group . 
 modified borg scale scores were 
 decreased significantly in the experimental vs. control group . 
 [ conclusion ] providing 
 caregivers with education pertaining to pulmonary rehabilitation was associated with 
 improved pulmonary function in lung cancer patients following lung resection . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION