Standard restrictive sternal precautions and modified sternal precautions had similar effects in people after cardiac surgery via median sternotomy (‘SMART’ Trial): a randomised trial

Katijjahbe, Ali; Granger, Catherine L; Denehy, Linda; Royse, Alistair; Royse, Colin; Bates, Rebecca; Logie, Sarah; Ayub, Ali Nur; Clarke, Sandy; El-Ansary, Doa

doi:10.1016/j.jphys.2018.02.013

Cited by 30 publications

(51 citation statements)

References 33 publications

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“…Data were collected from nested studies within two randomized controlled trials (published previously). 6,12–14 Reliability analyses data were from four different subgroups of participants within a multisite observational study (Table 1). Test–retest reliability was measured in 55 participants for single raters, and similar raters were used in Victoria’s Southern Health and Melbourne Health (Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…6 These are reported in prior publications outlining the study protocol. 6,12–14 As part of the original trials, participants also completed several other outcome measures (physical function, pain and health-related quality of life) at hospital discharge, four weeks and three months postoperatively. For this pyschometric investigation, data from all participants from the original trials were pooled and included.…”

Section: Methodsmentioning

confidence: 99%

“…Details of the description of all the outcome measures (The Short Physical Performance Battery, The Timed Up and Go test, The Numerical Pain Rating Scale, The Medical Outcomes Study 36-item Version 2 and The Global Rating of Change Scale) used in the original studies can be found in prior publications. 12–14…”

Section: Methodsmentioning

confidence: 99%

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Psychometric evaluation of the shortened version of the Functional Difficulties Questionnaire to assess thoracic physical function

et al. 2019

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Objective: The aim of this study was to investigate the psychometric properties of the shortened version of the Functional Difficulties Questionnaire (FDQ). Design: This is a multisite observational study. Setting: The study was conducted in four tertiary care hospitals in Australia. Subjects: A total of 225 participants, following cardiac surgery, were involved in the study. Intervention: Participants completed the original 13-item FDQ and other measures of physical function, pain and health-related quality of life. Method: Item reduction was utilized to develop the shortened version. Reliability was evaluated using intraclass correlation coefficients (ICCs), the smallest detectable change and Bland–Altman plots. The validity and responsiveness were evaluated using correlation. Anchor and distribution-based calculation was used to calculate the minimal clinical important difference (MCID). Results: Item reduction resulted in the creation of a 10-item shortened version of the questionnaire (FDQ-s). Within the cohort of cardiac surgery patient, the mean (SD) for the FDQ-s was 38.7 (19.61) at baseline; 15.5 (14.01) at four weeks and 7.9 (12.01) at three months. Validity: excellent internal consistency (Cronbach’s α > 0.90) and fair-to-excellent construct validity (>0.4). Reliability: internal consistency was excellent (Cronbach’s α > 0.8). The FDQ-s had excellent test–retest reliability (ICC = 0.89–0.92). Strong responsiveness overtime was demonstrated with large effect sizes (Cohen’s d > 1.0). The MCID of the FDQ-s was calculated between 4 and 10 out of 100 (in cm). Conclusion: The FDQ-s demonstrated robust psychometric properties as a measurement tool of physical function of the thoracic region following cardiac surgery.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Psychometric evaluation of the shortened version of the Functional Difficulties Questionnaire to assess thoracic physical function

et al. 2019

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“…16 Second, the ERAS Cardiac guidelines include no specific recommendations for early postoperative enteral feeding and mobilization, even though these measures are known to work together to stimulate resumption of gut function, preserve musculoskeletal function, and promote a faster and safer return to normal activities after surgery. [17][18][19][20][21][22] A sternotomy incision limits early mobilization and rehabilitation activities. Although the ERAS Cardiac guidelines do recommend that cardiac surgery programs develop multidisciplinary institutional guidelines to address early feeding and mobilization, 14 traditional sternal precautions prioritize the stability of the bony union over patient mobility, greatly limiting opportunities for return to normal activity and physical rehabilitation in the postoperative recovery period.…”

Section: Enhanced Recovery After Cardiac Surgerymentioning

confidence: 99%

Orthopedic Principles to Facilitate Enhanced Recovery After Cardiac Surgery

Gerdisch

Allen

Naka

et al. 2020

Critical Care Clinics

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Early patient mobilization is a major driver of recovery after cardiac surgery with open sternotomy. Instability of the healing sternal osteotomy hinders postoperative patient movement, causes pain, and puts patients at risk of complications, necessitating restrictive sternal precaution protocols. Sternal closure with wire cerclage does not adequately satisfy the three fundamental principles of orthopedic healing: approximation, compression, and rigid fixation. Selection of sternal closure methods according to orthopedic principles promotes accelerated recovery and return to normal activities while reducing pain and requirements for opioid analgesics.

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“…14 Findings from a recent study demonstrated that various upper limb tasks performed by patients within the safe limits of pain and discomfort after median sternotomy resulted in minimal bone motion with no adverse events. 15 Second, seat belt forces and airbag deployment may damage the healing sternum during a motor vehicle crash. Unquestionably, there are documented accounts of sternal fractures from motor vehicle accidents 16 associated with the use of seat belts 17 and the deployment of airbags.…”

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confidence: 99%