Effectiveness of Pediatric Respiratory Therapist-Led Early Pulmonary Rehabilitation on Post-Thoracic Surgery Lung Function: A Systematic Review and Meta-Analysis

Abstract

Background: Early pulmonary rehabilitation (PR) following adult thoracic and cardiac surgery is well established, yet the effectiveness of Respiratory Therapist (RT)-led early PR specifically on postoperative lung function after pediatric thoracic surgery has not been systematically evaluated. This review asks: what is the effectiveness of RT-led early PR on lung function in children undergoing thoracic surgery, and, where direct pediatric thoracic-surgical evidence is absent, what can be inferred indirectly from the broader pediatric surgical/respiratory literature and the adult thoracic/cardiac surgery PR evidence base.
Methods: A systematic, transparently-scoped search of relevant literature was completed (PubMed/MEDLINE, ClinicalTrials.gov, PMC, Frontiers, Google Scholar), using a fixed date range through August 2026, explicitly searching for RT-delivered as well as other provider-delivered early PR. Eligible designs included randomized controlled trials, non-randomized comparative studies and single-arm cohort studies, published 2020-2026, reporting pulmonary function, respiratory-muscle strength or functional exercise outcomes following facilitated mobilization, respiratory physiotherapy or structured PR. No study was identified that evaluated RT-led early PR specifically after pediatric thoracic surgery; studies were therefore organized as direct evidence (pediatric thoracic and general surgical, and pediatric non-surgical respiratory populations) and indirect comparative evidence (adult thoracic/cardiac surgical populations), used only to contextualize the size of the direct pediatric evidence gap. Risk of bias was assessed using RoB 2 for randomized studies and ROBINS-I logic for non-randomized/single-arm studies.
Results: Fifteen studies were identified (n=8 direct pediatric evidence; n=7 indirect adult thoracic/cardiac evidence). No study evaluated RT-led early PR after pediatric thoracic surgery specifically; the pediatric evidence base was instead drawn from general/abdominal pediatric surgery and non-surgical pediatric respiratory disease, and was overwhelmingly delivered by physiotherapists rather than Respiratory Therapists. A quantitative, descriptive meta-analytic synthesis was performed for the two studies with extractable mean/SD comparative pulmonary data (Bezgin et al., 2025; Kim et al., 2024); the remaining 13 studies were evaluated narratively (Synthesis Without Meta-analysis, SWiM approach), as pooling across such heterogeneous, mostly non-thoracic-surgical populations was not statistically defensible. In the pediatric literature, early rehabilitation was associated with improvements in respiratory muscle strength and functional exercise parameters, while effects on lung volumes were more variable. The indirect adult thoracic/cardiac surgical evidence suggests greater efficacy for integrated, multi-modal PR protocols over single-mode mobilization, with more consistent improvements in FEV1%/FVC% and reductions in postoperative pulmonary complications.
Conclusions: No study has yet evaluated the effectiveness of RT-led early PR on lung function after pediatric thoracic surgery, and this review's most clinically actionable finding is the existence of that gap itself. Indirect evidence from broader pediatric surgical and respiratory populations, and from the far more extensive adult thoracic/cardiac surgery literature, suggests benefit from structured, multi-component PR delivered by a dedicated provider rather than mobilization alone. Pediatric thoracic-surgery-specific randomized trials directly comparing RT-led to standard (typically PT-led) delivery are required before firm clinical recommendations can be made for this population.