SAMMANFATTNING Ländryggsbesvär är generellt vanligt förekommande i befolkningen och samhällsekonomiskt kostsamt. Riskfaktorer för ländryggsbesvär beskrivs vara flerdimensionella, där nämns främst arbetsrelaterade och psykosociala faktorer. Poliser är en yrkesgrupp där arbetssjukdomar rapporteras vanligt förekommande oavsett kön. Trots det är polisers arbetssituation dåligt utforskad. Syftet med studien är att kartlägga upplevt hälsotillstånd och arbetssituation bland utryckningspoliser med fokus på ländryggsbesvär, som underlag för preventiva åtgärder. Metoden bestod av en tvärsnittsstudie i form av en omfattande enkätundersökning. Urvalet inom polisens utryckningsenhet i Västerås var totalt. Så många som 60 % angav arbetsrelaterade ländryggsbesvär, en större del med besvär var män och förekomst av tunga lyft var vanligare bland svarande med besvär. Personer med ländryggsbesvär tog i mindre utsträckning pauser, kände sig stressade på arbetet och besvärades oftare av kroppslig värk. Deltagarna själva kopplade sina ländryggsbesvär till dåligt utformad arbetsutrustning, dålig sittställning i yrkesfordonen och till fysiska ingripanden. Av litteraturen beskrivna riskfaktorer för ländryggsbesvär var vanligt förekommande inom enheten. Där nämns ogynnsamma arbetsställningar och arbetsmoment samt psykosociala faktorer i form av hög arbetsbelastning, lågt stöd från arbetsledning och låg möjlighet att påverka sin arbetssituation. Slutsats: För att förbättra arbetsmiljön för utryckningspoliser bör åtgärder inriktas mot belastningsergonomiska- och psykosociala faktorer i arbetet samt utformning av utrustning och arbetsfordon utifrån ergonomi och säkerhet. / ABSTRACT Low back pain is a common disorder which causes high economic costs for the society. Risk factors for back pain are described as multidimensional, including both work related and psychosocial factors. Police-officers belong to an occupational group were work related diseases are frequently reported, irrespective of gender. The work situation for these officers however is poorly covered by targeted research. The purpose of this study is to survey the health- and work situation among police-officers with the focus on low back pain. The hope is that the results can be used as a base for preventive interventions. A cross sectional design with an extensive survey was used for the study. The selection was total within the unit of patrolling police officers in Västerås. As many as 60 % reported low back pain, with an overrepresentation among men. Heavy lifting was more common among those with low back pain. Those reporting low back pain more rarely took breaks during the work day, they felt more stressed at work and were more often troubled with physical pain. The study participants linked their back problems to badly designed work equipment, badly adjusted vehicles and to physical interventions. Risk factors for low back pain, described by the literature, were common within the unit. Especially, work tasks involving unfavorable movements and body positions were singled out. Among psychosocial factors, low social support from management and low ability to influence the work situation were associated with low back pain. Conclusion: To improve the work environment for patrolling police-officers, measures should be focused on load and strain ergonomics, psychosocial factors as well as to develop equipment and vehicles more on the basis of ergonomics and safety measures.

Omkring 10-20 % av personer med lumbalt diskbråck opereras. Operationen syftar främst till att behandla utstrålande smärta i nedre extremiteter. Beteenderelaterade faktorer kan påverka smärtupplevelsen vid långvariga smärttillstånd och viss forskning finns om hur resultatet av diskbråcksoperation påverkas av olika biopsykosociala faktorer. Syftet med denna studie var att undersöka hur smärtintensitet var associerat till vissa beteenderelaterade faktorer före och två år efter lumbal diskbråcksoperation, samt om dessa faktorer preoperativt kan predicera smärta efter diskbråcksoperation. Studien är en longitudinell deskriptiv kohortstudie där associationer analyseras. Data samlades in med en enkät före och efter operationen. Preoperativt besvarade 59 personer enkäten, två år senare upplevde 20 personer ingen smärta och besvarade därför inte de beteenderelaterade frågorna. Preoperativt fanns svaga till moderata korrelationer mellan smärta och de flesta beteenderelaterade faktorerna. Två år postoperativt fanns moderata till starka korrelationer mellan smärta och katastroftankar, rörelserädsla, ”möjlighet att minska smärta” respektive smärtkontroll men inte till self-statement. Postoperativ bensmärta vid aktivitet korrelerade med preoperativt högt skattad self-statement. Studiens resultat säger ingenting om kausalitet, men tyder på att effektiva copingstrategier kan förhindra att kronisk smärta utvecklas, mätt två år efter diskbråcksoperation. Resultatet kan också förklaras med att en från början låg smärtintensitet är lättare att hantera. / Approximately 10-20% of patients with lumbar disc herniation require surgical treatment. Surgery aims primarily to reduce radiating pain in the lower limbs. Behaviour related factors can affect the experience of pain in a long term conditions. Some research is available concerning the influence of different biopsychosocial factors on the outcome of disc herniation surgery. The aim of this study was to analyse the association between pain intensity and behaviour related factors before and two years after lumbar disc surgery. Further, the aim is to analyse the predictive value of these factors in relation to pain two years after surgery. The design is a longitudinal descriptive cohort trial where associations are analysed. Data were collected before and two years after surgery. Questionnaires were answered by 59 persons with lumbar disc herniation before surgery. As 20 of the responders had no pain two years postoperatively, these did not answer the questions related to behaviour related factors. Before surgery correlations were weak to moderate between most of the behaviour related factors and pain. Two years later pain correlated moderately and strongly to catastrophising, fear of movement, ability to decrease pain and pain control but not to self-statements. Conversely, leg pain in activity two years after surgery correlated with highly rated use of self-statements preoperatively. The results of the study say nothing about causal relationships but indicate that effective coping strategies can prevent the development of chronic pain, measured two years post surgery. Possibly, lower pain is easier to cope with, which could also explain the results.

Bakgrund: Hand-fot syndrom är en form av perifer sensorisk neuropati orsakad av cytostatikabehandling. Syndromet kan ge biverkningar såsom smärta, obehag, domningar, svullnad och nedsatt balans. Utvärderade behandlingsmetoder saknas. Syfte: Undersöka hur tolv veckors sjukgymnastisk behandling med långvågsdiametri, interferens och balansträning påverkar biverkningar i fot/underben orsakad av cytostatikabehandling hos sju patienter med hand-fot syndrom. Metod: Gruppstudie, kvasiexperimentell resultatstudie. Sju patienter deltog. Variabler som mättes var, smärta, obehag, domningar och balans. Tre mätningar utfördes, före, efter samt åtta veckor efter interventionen. Självrapporterad skattning och fysisk mätning användes. Resultat: Gruppens smärta, obehag och domningar minskade vid samtliga mätningar. För smärta visade mätning efter intervention samt åtta veckor efter signifikans (p=0,027), (p=0,042). Obehag visade signifikans efter interventionen (p=0,018). Domningar visade ingen signifikans. Balans visade signifikans i: Skärpt Romberg, höger, blundande, åtta veckor efter interventionen (p=0,043). Skärpt Romberg, vänster, blundande, efter interventionen (p=0,027), åtta veckor efter interventionen (p=0,028). Stående på ett ben, höger, blundande, efter interventionen (p=0,042), åtta veckor efter interventionen (p=0,027). Inga mätningar visade försämringar. Slutsats: Restultaten visade att behandling med långvårdsdiametri, interferens och balansträning minskade smärta, obehag, domningar och delvis förbättrade balans vid hand-fot syndrom. Dock går det inte att påvisa vilken behandlingskomponent som påverkat mest. Ytterligare studier behövs för att ge resultat större giltighet. / Background: Hand-foot syndrome is a form of perifier sensory neuropathy caused by chemotherapy. The syndrome can cause side effects such as pain, discomfort, numbness, swelling and impaired balance. Evaluated treatment is lacking. Purpose: Examine how twelve week physiotherapy treatment short-wave diathermy, interference and balance training affects side effects of the foot/lower leg caused by chemotherapy in seven patients with hand-foot syndrome. Method: Study group, quasi-experimental outcome study. Seven patients participated. Variables measured were, pain, discomfort, numbness, and balance. Three measurements were carried out, before, after, and eight weeks after the intervention. Self-reported estimates and the physical measurement were used. Results: The group's pain, discomfort and numbness decreased in all measurements. For pain measurement after the intervention and eight weeks after showed significance (p = 0,027),(p = 0,042). Discomfort showed significance after the intervention (p = 0,018). Numbness showed no significance. Balance showed significance in: Sharpened Romberg, left, eyes closed, eight weeks after intervention (p = 0,043). Sharpened Romberg, left, eyes closed, after the intervention (p = 0,027), eight weeks after intervention (p = 0,028). Standing on one leg, the right, eyes closed, after the intervention (p = 0,042), eight weeks after intervention(p = 0,027). No measurements showed deterioration. Conclusion: The results showed that treatment with short-wave diathermy, interference and balance training reduced pain, discomfort, numbness and partial improvements in balance in hand-foot syndrome. However, it is not possible to demonstrate which treatment component that affected the most. Further studies are needed to produce results more valid.

During the past few years there has been an observed decrease in physical fitness within different patient groups. As a part of the rehabilitating physiotherapy treatment it is important to acknowledge the physical condition of the patient. Physical fitness testing might be difficult due to physical limitations within different patient groups. A broad range of exercise tests is therefore of importance in clinical practice. The aim of this overview was to describe exercise tests used in rehabilitation contexts, and to define areas of use and restrictions. The method was a systematic literature overview and data was gathered through medical and healthcare databases. Scientific articles were selected and put together to answer the questions in the overview. The result showed that exercise tests mainly described in the literature were tests performed on a bicycle ergometer, treadmill tests and walking tests. The tests were in several cases combined with rating scales. The tests were performed as submaximal or maximal tests to estimate VO2max or VO2Peak. Exercise testing was commonly used in rehabilitation of cardiac- and vascular diseases, pulmonary diseases and spinal cord injuries. Evaluation of an exercise program was the most common reason for using an exercise test. The question concerning restrictions of the tests could not be answered. The conclusion was that the most common exercise test was performed on a bicycle ergometer. Maximal VO2Peak or VO2max testing were mainly performed. The most common area for exercise testing was cardiac- and vascular rehabilitation. The most common purpose for performing an exercise test was evaluation of an exercise program. Further research is required in order to describe restrictions and implementations of the tests.

Bakgrund: Varje individ rekommenderas att ägna sig åt någon form av fysisk aktivitet minst en halvtimme varje dag. Ett nytt arbetssätt är att skriva ut fysisk aktivitet på recept och en arbetsform för utskrivning kallas ordinerad fysisk aktivitet (OFA). Patientföljsamheten ökar genom personlig kommunikation mellan vårdgivare och patient, vårdpersonalens initiativ att kontakta patienten och patientens möjlighet till att aktivt deltaga i sin sjukdomsbehandling. Individens sjukdom eller skada, sociala intresse, personliga uppfattningar och omgivningens tillgänglighet för träning har betydelse för fysisk aktivitet enligt tidigare forskning. Syfte: Studiens syfte var att studera vilka faktorer som möjliggjorde för personer som har fått OFA i Västmanland att följa sin ordination. Metod: Studien var en kvalitativ intervjustudie med explorativ design. Kvalitativ innehållsanalys användes för bearbetning av intervjuerna. Resultat och slutsats: Personalens betydelse för illtro till egen förmåga att träna framträder som ett centralt tema i informanternas berättelse enligt författarnas tolkning. Temat uttrycks i olika koder, underkategorier och kategorier. Fysiska faktorer som är betydelsefulla är kroppen och hälsan. Psykologiska faktorer är individens organisatoriska förmåga, tankar, känslor och erfarenheter samt personliga förhållningssätt. Närstående, personalen och deras insatser samt den fysiska miljön är betydelsefulla omgivningsfaktorer. Den sociala gemenskapen med familj och träningskamrater beskrivs också som betydelsefulla för att komma igång med OFA. / Background: Every individual are recommended to spend at least thirty minutes per day with some form of physical activity. Writing prescription of physical activity is a new approach and one form of prescription is called prescribed physical activity (OFA). Patient compliance increases through personal communication between health care professionals and patients, initiative from health care professionals and patients’ possibility to take active part in their own treatment. A person’s injury or illness, social interest, personal preferences and exercise possibilities in the environment has importance for physical activity according to previous research. Purpose: The aim was to study what factors that made it possible for persons that have been prescribed physical activity (OFA) in Västmanland to follow their prescription. Method: The study was a qualitative interview study with explorative design. Qualitative content analysis was used for analysing the interviews. Results and Conclusion: Personnel’s importance for confidence in the ability to exercise appears as a central theme in the informants’ statement according to the authors’ interpretation. The theme is expressed in different codes, subcategories and categories. Important physical factors are body and health. Psychological factors are a person’s organizational ability, thoughts, feelings and experiences as well as personal adaptive attitude. Family, personnel and their contribution and the physical surroundings are important environmental factors. The social fellowship with family and exercise partners is also described as important in order to get started with OFA.

Hand function is of great importance in the many daily activities that require well-coordinated hand and arm movements. Measurement of hand function is an essential element in the rehabilitation process, in order to facilitate medical diagnosis and determine developmental stages, functional levels, and the efficacy of treatment interventions. Basic requirements for any measurement used in clinics are that they are easy to use, relevant to the function being assessed, and valid and reliable. When scrutinizing the literature on hand function, important gaps were found with regard to measurement. For example, the reliability of grip strength with the Grippit in children has yet to be determined, and there are few evaluations of hand function measurements in Charcot-Marie-Tooth disease (CMT). Furthermore, laboratory measurements of hand function, which have the potential to provide more detailed information and insight into hand control, such as the role of the cerebellum in reactive grip control – have not been fully explored. The overall aim of the thesis was to achieve more knowledge on hand function; on the evaluation of measurements in different target populations; and on movement control of the hand. In the first study, the aim was to evaluate the test-retest reliability of the peak and sustained grip strength with Grippit in a sample of healthy children (n=58, 6-, 10- and 14-y-olds). This was followed by two studies examining hand function in an adult sample (n=20) diagnosed with CMT. The test-retest reliability of grip and pinch strength using Grippit, sensation with the Shape Texture Identification test (STI) and dexterity with the Box and Block Test (BBT) and Nine-Hole Peg test (NHP) were studied. The impact of the disease on daily life, measured with the Disability of the Arm, Shoulder and Hand questionnaire (DASH), and correlations between disability and various aspects of hand function, were also explored in this condition. The aim of the fourth study was to examine grip force response to unpredictable loadings of an object held in a pinch grip in subjects (n=9, 22-48 yrs) who had been diagnosed with a cerebellar lesion, compared with a healthy control group (n=11). The first study showed that test-retest reliability was good for both peak and sustained grip strength in healthy children. The mean and best of three trials were equally reliable, but differences in reliability were detected within different age groups. For example, the peak grip strength, best of three trials, was more reliable for the 6-y-olds (intraclass correlation coefficient (ICC)=0.96, standard error of measurement in percentage (SEM%)=6.3) and 14-y-olds (ICC=0.96, SEM%=5.2) compared with the 10-y-olds (ICC=0.78, SEM%=12.5). In the second study, evaluating measurements of hand function in subjects with CMT, grip strength proved to be reliable (ICC=0.99, coefficient of repeatability (CR)=26.7 N, coefficient of variation (CV)=6.6 %), but pinch strength was less reliable. The reliability was also good for the BBT (ICC=0.95, CR=11.5 blocks/min, CV=8.4%) and the NHP (ICC=0.99, CR=4.3 s, CV=3.9 %). However, a bias towards higher values was noted on the second test occasion with the BBT. The reliability of the STI test (kappa=0.87) was also very good in subjects with CMT. A limitation in this latter test was noted in terms of its ability to describe subjects either performing very well or very poorly. The results of the third study showed that hand function in CMT was reduced (p<0.001) to about 60% of that in healthy controls in each of the separate outcome measures, as well as by a constructed summary index of hand function. The median DASH score was 38.8 (range 0-66.7) and was clearly related to hand function (r=0.64-0.83). The results of the final study in subjects with cerebellar lesions showed that the ipsilateral hand had delayed and more variable response latencies e.g. 278±166 ms for loads delivered at 2 N/s, compared with healthy subjects (HS) 80±53 ms (p=0.005). The cerebellar subjects also used a higher pre-load grip force with the ipsilateral hand (1.6±0.8 N) than the HS (1.3±0.6 N (p=0.017)). Even the contralateral hand in subjects with unilateral cerebellar stroke showed a delayed onset of the grip response. In conclusion: Grip strength assessment in children with Grippit results in good reliability for peak and sustained grip strength, although the 10-y-olds were less reliable. In CMT the tested instruments can all be used to evaluate hand function, but certain factors, such as the number of trials used should be taken into consideration. The CMT subjects’ hand function was reduced and correlated with their self-experienced disability. However, clinicians should be aware that patients might score lower than expected on DASH, possibly due to a long process of adaptation. Cerebellar lesions can impair the reactive grip control in both the ipsilateral and the contralateral hand. These investigations have thus, as intended increased the knowledge of hand function. The studies have evaluated some measurements in different samples, which will help clinicians testing hand function.

As motion interactive games have become more widespread the interest in using these games in rehabilitation of children with motor disorders has increased among both clinical professionals and the families of these children. The general aim of this thesis was to evaluate the feasibility of using interactive games in rehabilitation of children to promote motivation for practice, physical activity, and motor control. A systematic review of published intervention studies was conducted to obtain an overview of existing research and the current levels of evidence for using interactive games in motor rehabilitation of children. Sixteen studies met the inclusion criteria, out of these three were randomized controlled trials while half were case series or case reports. Thirteen studies presented positive findings, which indicated a promising potential. However, more convincing research is needed. Commercially available motion interactive games have only been used in a few studies on motor control, and in none of these home based practice was provided. Moreover, no earlier studies have evaluated if these games may increase motivation for training and daily physical activity among children with disabilities. To address these issues a feasibility intervention including 15 children in the ages 6-16 years and with mild to moderate cerebral palsy was conducted. Each child was provided with a Sony PlayStation2â and the EyeToyâ games in Play3, and was recommended to practice with the provided games for at least 20 minutes/day during four weeks. The intervention was evaluated with gaming diaries, physical activity monitors (SenseWear Armband), interviews with the parents, and the clinical motor tests Movement Assessment Battery for Children-2 (mABC-2), Bruininks-Oseretsky Test of Motor Proficiency subtest 5:6, and the 1 Minute Walk Test. In addition, 3D motion analysis was used to evaluate effects on quality of goal-directed arm movements towards virtual and real objects, respectively. Motivation for practice and compliance of training were high, although declining somewhat during the course of the four weeks. The children’s physical activity increased significantly during the intervention. However, four children were excluded from this analysis due to lack of complete data from the physical activity monitors. According to mABC-2 the children’s motor performance improved, but there were both floor and ceiling effects, indicating a low sensibility of this test. The two additional motor tests showed only non-significant progress. Results from the 3D motion analysis suggest that the children improved movement precision when playing the games, movement smoothness when reaching for real objects, and used a more economic reaching strategy with less trunk involvement. In the interviews the parents expressed the view that motion interactive games promote positive experiences of physical training and add elements of social interaction to the training. They also experienced less urge to take on a coaching role. The training provided by the games was considered unspecific and there was a desire for individualized games to better address the unique rehabilitative need of each child. In conclusion, it is feasible to use motion interactive games in home rehabilitation for children with cerebral palsy to promote short term motivation for practice and general physical training. Specific effects on motor control need to be further explored and there is also a need for reliable tests that are adequate and sensitive enough to capture changes in movement control. In future development of interactive games for rehabilitation purposes, it is a challenge to preserve the motivational and social features of games while at the same time optimizing an individualized physical training.

Studier har visat att det är viktigt att ge kvinnor evidensbaserad information och råd kring träning och graviditet. Syftetmed studien var att undersöka frågeställningen: Upplever kvinnor efter sin förlossning att de fick kunskap under sin graviditet kring fysisk aktivitet och träning? Metodensom användes var en enkätundersökning och ett av inklutionskriterierna var att man skulle ha fött sitt barn inom de senaste 24 månaderna. Resultatetav studien baserades på 360 enkätsvar vilka visade 70 % av de svarande anser att de inte fått tillräcklig information om träning under graviditeten. Av de svarande som ansåg sig fått tillräckligt med kunskap om fysisk aktivitet under graviditeten fick 39 % den informationen från en fysioterapeut, flest av alternativen. 52 % av de svarande bedömde sin kunskap om träning och graviditet som låg under graviditeten. Enkätresultaten visade också att 86 % av de svarande som bedömde sig ha hög eller mycket hög kunskap om gravidträning under graviditeten gjorde en förändring i sin träning. Det var sex procentenheter högre än resultatet bland alla respondenter. Slutsatsenav studien visade indikationer på att de kvinnor som träffat en fysioterapeut under sin graviditet i högre grad verkar uppleva att de fått information om hur de bör träna under graviditeten. Det bör undersökas genom vidare studier.

<p>The aim of this investigation was to elucidate and describe those patients who had discontinued their participation and/or paticipated infrequently in physiotherapy treatment based on their own activity and responsibility. The ambition was to understand the phenomenon of compliance/adherence from various perspectives in behavioural as well as social science.</p><p>In study I the phenomenon compliance/adherence was studied in relation to Health Locus of Control and Health Belief variables. This study was based on a questionnaire that was answered by all patients before beginning of treatment. Questions concerning the patients´conceptions about both health locus of control and health beliefs were the focus.The definitions of compliance/adherence were completed treatment period and exercise frequency, respectively. Those patients who completed the treatment were also studied regarded exercise frequency.</p><p>The results of study I showed that those who discontinued their treatment reported a higher perceived threat from their health condition (higher level of dysfunction (higher pain intensity) and a higher perceived severity of their health condition (higher level of dysfunction, worse general health) than those who completed treatment. The results also showed that those who exercised once a week or less often valued the significance of the caring situation as lower (HLC), perceived a higher threat from their health condition (higher pain intensity), a higher severity of their health condition (higher level of dysfunction, worse general health, greater distrution of impairment), more barriers to treatment (lower expectations), and had certain differences in demographic variables (younger individuals, more women) than those who exercised more often (HB).</p><p>Study II investigated patients´descriptions of their reasons for discontinuing the treatment, whether those reasons varied, and if so how they varied. Sixteen patients who had discontinued their treatment were interviewed with open-ended questions. The inteviews began with a question about the background to the physiotherapy treatment. There were questions concerning carrying out the treatment as well as concerning what they thought about their impairment. The patients were also asked about their priotities in daily life, as these wre presumed to be anobstacle to the treatment over a shorter or longer period of time. The third domain concerned how they experiebced the patient/physiotherapist relationship. The interviews were anlysed qualitatively.</p><p>Analysis of study II resulted in four different descriptions of reasons for treatment discontinuation. A) It was about time to end treatment and continue on alone. B) The treatment was not the most important activity to spend time on. C) An agreement with the physiothreapist to discontinue treatment due to lack of effect. D) No viewpoint as to why they discontinued the treatment. In further analysis of category D, this group appeared to experience varoius forms of powerlessness. They felt their trustworthiness was often questioned. They experienced frustration in their life situation as others made the important descisions and they themselves had little to say.They defended themselves by talking about their own conceptions of the reasons for their impairment and what should be done about them. In comparing category D with categories A, B, C it was found that those in the latter three categories experienced varying degrees of control in different situations, whereas those in category D did not experience a feeling of control.</p><p>Conclusion: The concept of compliance in physiotherapy is ambiguous. The concept involves one part defining what will concern the other part. It is clear that the physiotherapist and the patient do not always agree about the aim of the treatment. Instead, we should develop the concept of concordance in encounters with the patients and abandon the reasoning of compliance.</p>

<p>Deep breathing exercises are widely used in the postoperative care to prevent or reduce pulmonary complications, but no scientific evidence for the efficacy has been found after coronary artery bypass grafting (CABG) surgery. </p><p>The aim of the thesis was to describe postoperative pulmonary function and to evaluate the efficacy of deep breathing exercises performed with or without a blow bottle device for positive expiratory pressure (PEP) 10 cmH₂O or an inspiratory resistance-positive expiratory pressure (IR-PEP) mask with an inspiratory pressure of -5 cmH₂O and an expiratory pressure of +10 to +15 cmH₂O. </p><p>Patients undergoing CABG were instructed to perform 30 slow deep breaths hourly during daytime for the first four postoperative days. Patient management was similar in the groups, except for the different breathing techniques. </p><p>Measurements were performed preoperatively, on the fourth postoperative day and four months after surgery. The immediate effect of the deep breathing exercises was examined on the second postoperative day. Pulmonary function was assessed by spirometry, diffusion capacity for carbon monoxide and arterial blood gases. Atelectasis was determined by chest roentgenograms or spiral computed tomography (CT). </p><p>Lung volumes were markedly reduced on the fourth postoperative day. Four months after surgery the pulmonary function was still significantly reduced. On the second and fourth postoperative day all patients had atelectasis visible on CT. A single session of deep breathing exercises performed with or without a mechanical device caused a significant reduction in atelectasis and an improvement in oxygenation. No major differences between deep breathing performed with or without a blow bottle or IR-PEP-device were found, except for a lesser decrease in total lung capacity in the blow bottle group on the fourth postoperative day. Patients who performed deep breathing exercises after CABG had significantly smaller atelectasis and better pulmonary function on the fourth postoperative day compared to a control group who performed no exercises.</p>