Different physiotherapy protocols after coronary artery bypass graft surgery: A randomized controlled trial

Abstract

Background and purpose The aim of this study was to investigate the influence of different physiotherapy protocols on heart rate variability (HRV) and hospital length of stay in older adults undergoing coronary artery bypass graft (CABG). Methods Randomized controlled trial with allocation and researcher blinding and intention‐to‐treat analysis. Forty‐eight patients undergoing CABG were randomly assigned to a control group (CG), early mobilization group (EMG), or virtual reality group (VRG). CG performed respiratory physiotherapy and metabolic exercises, the EMG performed cycle ergometer exercises and ambulation, and the VRG performed the same activities as the EMG, with the addition of two Nintendo Wii games during 3 postoperative days. The variables of heart rate variability on preoperative and fourth postoperative day, and time of discharge of hospital was analyzed. Results The VRG presented a shorter hospital length of stay (p = 0.03). The CG showed a decline in HRV from the preoperative period to fourth postoperative day on square root of the mean of the squared differences between successive RR intervals (33.18 ± 9.89–9.74 ± 6.88, p < 0.05), standard deviation of all RR intervals (25.48 ± 7.50–15.23 ± 11.27, p < 0.05), and dispersion of points perpendicular to identity line (28.26 ± 21.6–2.73 ± 1.31, p < 0.05). The EMG and VRG presented a higher cardiac autonomic modulation compared to the CG (p < 0.05), with improved parasympathetic activity. Conclusions Different protocols of physiotherapy intervention affected autonomic modulation of the heart rate and hospital length of stay in patients undergoing CABG.

Efficacy of Early and Enhanced Respiratory Physiotherapy and Mobilization after On-Pump Cardiac Surgery: A Prospective Randomized Controlled Trial

“…Our results are consistent with those of other studies [ 8 , 9 , 13 , 14 ] indicating that early mobilization can decrease hospitalization length. Furthermore, a meta-analysis conducted by Y. Kanejima et al suggested that early mobilization after cardiac surgery might improve physical function at discharge and subsequently prevent prolonged hospital stays [ 11 ].…”

“…Furthermore, significant variability exists in physiotherapy strategies and early mobilization practices [ 6 ]. Several studies have attempted to examine whether physiotherapy and rehabilitation might be an effective non-pharmacological tool to improve post-operative outcomes and reduce hospitalization stay [ 7 , 8 , 9 , 10 , 11 ]. Nonetheless, none of them investigated the influence of intensified/intensive post-operative physiotherapy and rapid mobilization.…”

Exercise training and cardiac autonomic function following coronary artery bypass grafting: a systematic review and meta-analysis

“…Twenty-two studies were not included because they lacked a population sample [25], assessed outcomes not pertinent to the review [26,27], lacked a randomized and controlled design [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42], lacked a control group [43,44] and were not in English [45,46]. For the qualitative synthesis, eleven studies were used [47][48][49][50][51][52][53][54][55][56][57] out of which only eight studies [47-49, 51-54, 56] were included for meta-analysis as data provided in the remaining three studies were in unsuitable form [50,55] and insufficient [57]. The PRISMA 2009 flow diagram depicts the study selection procedure (Fig.…”

“…In total, 620 participants from 11 studies-with sample population ranging from 28 to 100 and an average age of 50 to 64 years-were reported, with 339 in the exercise group and 281 in the control group. Eight trials had only male participants [48][49][50][51][52][55][56][57] two trials [53,54] had both sexes, and one trial [47] did not specify the gender of the participants. CABG surgery had been performed on all of the participants.…”

“…CABG surgery had been performed on all of the participants. The proportion of patients taking beta-adrenergic blocking drugs ranged from 0 to 100%, according to 9 trials (90.90%) [48][49][50][51][52][54][55][56][57].…”