In Reply We appreciate the comments and critiques offered by Fernandez-Bustamante et al in their thoughtful letter regarding our work on the lack of effectiveness of incentive spirometry (IS) following bariatric surgery.1 They are correct in that use of IS in our study “was strictly an order set for nursing care, without any control over its implementation or patient performance.” It was our goal to design and conduct a pragmatic trial that replicated the way IS is implemented in a true clinical setting, thus making our findings applicable to everyday practice. We agree with their statement that “IS compliance is scarcely and inconsistently reported in clinical trials, which is essential to evaluate its effectiveness.” However, to our knowledge, a standardized and evidence-based value for the appropriate frequency of IS use does not exist.2 In the absence of a normal, evidence-based reference range and with our reported frequency of IS use falling within normally reported values in the literature,3 we believe that our control group, despite its “incredibly low compliance,” is an accurate and appropriate representation of actual IS use observed on surgical floors.
Pantel H, Schnelldorfer T, Nepomnayshy D. Incentive Spirometry After Bariatric Surgery—Reply. JAMA Surg. Published online June 21, 2017. doi:10.1001/jamasurg.2017.1678