Cardiovascular and respiratory responses to early ambulation and stair climbing following coronary artery surgery

Cockram, Joanne; Jenkins, Sue; Clugston, R.

doi:10.1080/095939899307856

Cited by 14 publications

(6 citation statements)

References 28 publications

(32 reference statements)

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“…Since then the practice of postoperative physiotherapy has changed in response to advances in medical and surgical knowledge [ 10 ]. Today there is an agreement as to the value of early mobilization and positioning after cardiac surgery [ 11 - 13 ], despite the risk of postoperative cardiac dysfunction [ 6 , 14 ]. Almost all physiotherapists in our study mobilized their patients with regard to sitting and standing on postoperative day 1.…”

Section: Discussionmentioning

confidence: 99%

Physiotherapy-supervised mobilization and exercise following cardiac surgery: a national questionnaire survey in Sweden

Westerdahl

Möller

2010

J Cardiothorac Surg

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BackgroundLimited published data are available on how patients are mobilized and exercised during the postoperative hospital stay following cardiac surgery. The aim of this survey was to determine current practice of physiotherapy-supervised mobilization and exercise following cardiac surgery in Sweden.MethodsA prospective survey was carried out among physiotherapists treating adult cardiac surgery patients. A total population sample was identified and postal questionnaires were sent to the 33 physiotherapists currently working at the departments of thoracic surgery in Sweden. In total, 29 physiotherapists (response rate 88%) from eight hospitals completed the survey.ResultsThe majority (90%) of the physiotherapists offered preoperative information. The main rationale of physiotherapy treatment after cardiac surgery was to prevent and treat postoperative complications, improve pulmonary function and promote physical activity. In general, one to three treatment sessions were given by a physiotherapist on postoperative day 1 and one to two treatment sessions were given during postoperative days 2 and 3. During weekends, physiotherapy was given to a lesser degree (59% on Saturdays and 31% on Sundays to patients on postoperative day 1). No physiotherapy treatment was given in the evenings. The routine use of early mobilization and shoulder range of motion exercises was common during the first postoperative days, but the choice of exercises and duration of treatment varied. Patients were reminded to adhere to sternal precautions. There were great variations of instructions to the patients concerning weight bearing and exercises involving the sternotomy. All respondents considered physiotherapy necessary after cardiac surgery, but only half of them considered the physiotherapy treatment offered as optimal.ConclusionsThe results of this survey show that there are small variations in physiotherapy-supervised mobilization and exercise following cardiac surgery in Sweden. However, the frequency and duration of exercises and recommendations for sternal precautions reinforced for the healing period differ between physiotherapists. This survey provides an initial insight into physiotherapy management in Sweden. Comparison with surveys in other countries is warranted to improve the physiotherapy management and postoperative recovery of the cardiac surgery patient.

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Section: Discussionmentioning

confidence: 99%

Physiotherapy-supervised mobilization and exercise following cardiac surgery: a national questionnaire survey in Sweden

Westerdahl

Möller

2010

J Cardiothorac Surg

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“…1–4 Among elderly patients in particular, lack of activity during their hospitalization is independently associated with higher mortality, decline in functional status, increase in readmission rates, and greater rates of nursing home placement. 5–7 …”

Section: Introductionmentioning

confidence: 99%

Effects of an Ambulation Orderly Program Among Cardiac Surgery Patients

Miwa

Visintainer

Engelman

et al. 2017

The American Journal of Medicine

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Background Despite the known benefits of ambulation, most hospitalized patients remain physically inactive. One possible approach to this problem is to employ Ambulation Orderlies (AOs) – employees whose main responsibility is to ambulate patients throughout the day. For this study, we examined an AO program implemented among post-cardiac surgery patients and its effect on patient outcomes. Methods We evaluated post-operative length of stay, hospital complications, discharge disposition, and 30-day readmission for all patients who underwent coronary artery bypass and/or cardiac valve surgery in the nine months before and after the introduction of the AO program. In addition to pre-post comparisons, we performed an interrupted time series analysis to adjust for temporal trends and differences in baseline characteristics. Results We included 447 and 478 patients in the pre- and post-AO intervention groups, respectively. Post-operative length of stay was lower in the post-AO group, with median (IQR) of 10 (7,14) days versus 9 (7,13) days (p<0.001), and also had significantly less variability in mean monthly length of stay (Levene’s test p=0.03). Using adjusted interrupted time series analysis, the program was associated with a decreased mean monthly post-operative length of stay (-1.57 days, p=0.04), as well as a significant decrease in the trend of mean monthly post-operative length of stay (p=0.01). Other outcomes were unaffected. Conclusion The implementation of an AO program was associated with a significant reduction in post-operative length and variability of hospital stay. These results suggest that an AO program is a reasonable and practical approach towards improving hospital outcomes.

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“…After open heart surgery, deterioration of functional capacity can be triggered by muscle weakness and proteolysis, induced by reduced mobility. Prolonged inactivity and muscle atrophy are responsible for atelectasis, sensation of fatigue and aspiration pneumonia, which render rehabilitation a 'highly recommended' healthcare strategy in post-operative period of invasive cardiac procedures [17][18][19]. Therefore, the presence of a multi-professional team including physiotherapists in the ICU is proven by several studies to contribute to early patient recovery, reduced mechanical ventilation support need, and ultimately less number hospitalization days, by preventing respiratory complications [20].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Early Respiratory Physiotherapy and Mobilization After on-pump Cardiac Surgery: a Prospective Randomized Controlled Trial

Afxonidis

Moysidis

Papazoglou

et al. 2021

Preprint

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Objective: This randomized controlled trial aimed to investigate the influence of physical activity and respiratory physiotherapy on zero postoperative day on clinical, hemodynamic and respiratory parameters of patients undergoing cardiac surgeries under extracorporeal circulation.Methods: 78 patients undergoing coronary artery bypass graft (CABG) or/and valvular heart disease surgeries were randomly assigned into active physiotherapy group (APG; n=39) and conventional physiotherapy group (CPG; n=39). Treatment protocol for APG included ≤3 Mets of physical activity and respiratory physiotherapy on zero post-operative day and an extra physiotherapy session during the first three post-operative days, whereas CPG was treated with usual physiotherapy care after the first post-operative day. The length of hospital and intensive care unit (ICU) stay were set as the primary study outcomes, while pre- and post-intervention measurements were also performed to assess the oxymetric and hemodynamic influence of early mobilization and physiotherapy. Results: Participants’ mean age was 51.86 ±13.76 years. Of them 48 (61.5%) underwent CABG. Baseline and peri-procedural characteristics did not differ between the 2 groups. The total duration of hospital and ICU stay were significantly higher in the CPG compared to the APG (8.1±0.4 versus 10.2±0.6 days and 32.1±1.7 versus 23.2±0.6 hours, p<0.001, respectively). Statistically significant differences in pre-intervention oxygen saturation, and post-intervention PO2 and lactate levels were also observed between the 2 groups (p=0.022, 0.027 and 0.001, respectively). Conclusion: In on-pump cardiac surgery, early and active post-procedural physical activity (≤3 METS) can prevent prolonged ICU stay and decrease the duration of hospitalization whilst ameliorating post-operative hemodynamic and oxymetric parameters.

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Cardiovascular and respiratory responses to early ambulation and stair climbing following coronary artery surgery

Cited by 14 publications

References 28 publications

Physiotherapy-supervised mobilization and exercise following cardiac surgery: a national questionnaire survey in Sweden

Physiotherapy-supervised mobilization and exercise following cardiac surgery: a national questionnaire survey in Sweden

Effects of an Ambulation Orderly Program Among Cardiac Surgery Patients

Efficacy of Early Respiratory Physiotherapy and Mobilization After on-pump Cardiac Surgery: a Prospective Randomized Controlled Trial

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