None listed
Conditions
Brief summary
In Australia 33,000 open-heart surgery operations are performed annually via an incision at the breast bone. Chest pain and non-union of the breast bone have been reported as complications following cardiac surgery. This is significant as if patients have pain that persists beyond 6 weeks it is more likely to continue as chronic sternal pain thus highlighting the importance of optimal pain management in the initial post-operative period. Following surgery patients are encouraged to observe sternal precautions that restrict the use of their arms and trunk to prevent these complications. These precautions are applied across Australia and worldwide practice without evidence to support them. Sternal precautions may be overly restrictive and not necessary for all patients as they may delay recovery by impacting on function. Upper limb movements have been shown to reduce post-operative pain and improve function. The aim of this project is to examine whether modified precautions that allow the use of the upper limbs and trunk within safe limits will facilitate recovery and function following cardiac surgery via a median sternotomy.
Interventions
The intervention group will follow modified sternal precautions (MSP) that will include asking the participants to:
1.use both arms and keep them close to the body when lifting light objects or standing up from a chair and getting out of bed
2.avoid pushing or pulling with one arm
3.support the chest with a cushion/folded towel when coughing
Participants will be instructed to use comfort to set the safe limits. They will also be encouraged to do active exercises of the upper limbs and trunk e
The intervention group will follow modified sternal precautions (MSP) that will include asking the participants to: 1.use both arms and keep them close to the body when lifting light objects or standing up from a chair and getting out of bed 2.avoid pushing or pulling with one arm 3.support the chest with a cushion/folded towel when coughing Participants will be instructed to use comfort to set the safe limits. They will also be encouraged to do active exercises of the upper limbs and trunk e.g. arm forward elevation to a point of comfort to the right and left, trunk rotation to a point of comfort. The participants will be encouraged to perform these exercise three times daily and repeat each exercise fifteen times. This will take approximately 20 minutes per session. The intervention will commenced within a week following cardiac surgery. The participants will receive the group training led by the treating physiotherapist. This will be a one-off group training session to teach participants the exercises and precautions they should adhere to (30 minutes). This will be supported with written information that includes a handbook of exercises and post-operative guidelines that include sternal precautions. Each participant will be provided with a flyer developed for the trial that has images and clear instructions regarding sternal precautions specific to their group (i.e modified sternal precautions group). This intervention will be applied for a period of six weeks. Telephone calls to measure adherence to the sternal precautions guidelines by a physiotherapist will be conducted weekly for the first 6 weeks and monthly from then until three months post-operatively.
Sponsors
University of Melbourne
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1.Cardiac surgical procedures, involving a median sternotomy (CABG, valve surgery or combination or both). 2.Able to provide informed consent. 3.Aged over 18 years of age
Exclusion criteria
Insufficient English comprehension to provide informed consent, complete simple, written questionnaires and/or understand simple, verbal instructions.
Outcome results
None listed