The interactions between group and time will be examined first to assess the effect of intervention, and, if no interaction is present, then group and time main effects will be examined.
If there are participants who are not following the assigned group protocol, we will consider a supplementary per-protocol analysis. Key secondary outcome data including upper limb function, pain, kinesiophobia and HRQoL will be summarised and analysed similarly to the primary outcome. Logistic regression will be used to determine pre-, peri- and post-operative risk factors associated with the development of post-sternotomy complications.
This will be an exploratory analysis which may identify trends of predictors reported in the literature having an individual effect on post-operative sternal complications i.
The manuscript will be prepared for submission, by July The S. The benefits of modifying sternal precautions have not been established, despite emerging evidence indicating that a precautionary approach rather than a restrictive approach may be preferable in this patient population [ 8 , 17 , 19 , 62 ]. This will be the first randomised controlled trial using an intervention group to modify sternal precautions and to study its effectiveness in improving physical function in this population.
Patients worldwide are currently being prescribed sternal precautions that restrict the use of their upper limbs and trunks to prevent sternal complications for 4—6 weeks [ 8 , 14 , 25 ]. The aims of this restriction are to promote sternal osteosynthesis and bone healing by minimising motion between the sternal edges [ 8 , 15 , 63 ]. However, the effect of sternal precautions on patient outcomes is unknown, with significant variation among institutions worldwide [ 8 , 13 , 14 , 26 ]. In addition, there is limited evidence to support their widespread application in clinical practice [ 8 , 13 , 15 , 18 , 62 , 64 , 65 ].
Previous studies have shown that unsupported, frequent coughing is the single main cause of mechanical stress through the sternum and may be a far more significant factor in the development of sternal complications [ 17 , 19 ].
Therefore, it was proposed that strict post-operative movement restrictions may not be necessary for all patients [ 8 , 13 ]. However, upper limb movements are part of post-operative standard physiotherapy treatment.
Concurrently, patients are encouraged to perform active movements of the upper limbs as part of their post-operative care following cardiac surgery with the aim of restoring physical function [ 8 ]. This creates a clinical dilemma collectively for both health professionals and patients [ 8 , 13 ]. On the basis of findings of a recent survey conducted in Australia [ 13 ], we have chosen to modify sternal precaution guidelines encouraging the use of bilateral upper limbs and trunk activities with pain and discomfort as a safety guide in the intervention group to optimise sternal healing and functional recovery in this patient population.
Specifically, participants will be allowed to resume their normal load-bearing activities at their own pace within pain-free limits by keeping their upper arms close to their body for common activities e. We hypothesise that this intervention will be safe and cause no harm to the participants.
In addition, prior research suggests that unloaded movements within a pain-free range and loaded activity with the upper arms close to the body will not cause excessive stress on the sternal surgical site or bone [ 8 , 19 , 62 , 65 ].
Encouraging movement of upper limbs and trunk activities early after cardiac surgery in the post-operative period is recommended in clinical practice worldwide [ 8 , 14 , 25 ] to improve functional outcome [ 22 ]. Clinical recommendations will be informed by future analysis of the efficacy of the trial in improving physical function and other associated outcomes.
This study will address the paucity of research and the inconsistent recommendations worldwide with respect to sternal precautions and associated restrictions to upper limb and trunk provided to the large number of individuals undergoing cardiac surgery via median sternotomy worldwide.
In particular, this research will inform guidelines for the commencement of upper limb exercises in cardiac rehabilitation and standards for sternal precautions and management following cardiac surgery. Coronary revascularization trends in the United States, — Heart disease and stroke statistics— update: a report from the American Heart Association. Article PubMed Google Scholar. Cheng A, Slaughter MS.
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Sternal precautions are used after open heart surgery to prevent the breastbone from pulling apart as it is healing. These precautions are meant to protect you and to reduce the risk of infection in your healing sternal incision. If you have had open heart surgery, then you may require the skilled services of physical therapy in a cardiac rehabilitation setting, where you can work on improving your strength, endurance, and functional mobility. Sternal precautions are also likely to be used during therapy.
However, they've recently been the subject of debate among some cardiac experts. Read on to find out what sternal precautions are and the latest thinking on how to care for yourself after a sternotomy. Open heart surgery usually requires that your cardiac surgeon divide your sternum breastbone to gain access to your heart and surrounding structures. After the surgery, your surgeon must repair your sternum by returning the bone to its proper place.
Usually, a strong wire is used to hold the bone together while healing occurs. During your recovery, your healthcare provider may instruct you to follow sternal precautions—a method to protect your sternum after you've had open heart surgery. Sternal precautions are adjustments that you need to make in your day-to-day life to help prevent the separation of your breastbone as it heals.
Separation of your sternum may slow the healing process of the bone, and sternal precautions also help to prevent excessive pulling on the surgical incision.
This may help to keep the skin closed to prevent infection in your incision. Excessive pulling on your breastbone while it is healing after open heart surgery can cause something called dehiscence, or a separation of the bone. This separation can become an opening for infection to enter into your body.
If you've had open heart surgery, you must follow your healthcare provider's orders, since some healthcare providers use different surgical techniques and have different requirements after surgery.
You must fully understand what is expected of you after open heart surgery. Sternal precautions include:. Your sternal precautions may be different depending on your surgeon or the facility in which you are participating in acute cardiac rehabilitation. Some healthcare providers, for example, allow you to reach one arm overhead, and others allow you to lift up to 10 pounds. Be sure to speak with your healthcare provider to understand your specific sternal precautions. Your physical therapist can work with you in cardiac rehabilitation to help you understand and maintain your sternal precautions.
You may find that basic functional mobility is difficult while maintaining sternal precautions. Your physical therapist can teach you how to move around while maintaining your surgeon's suggested precautions. Modifications you may learn include:. If your healthcare provider asks you to follow sternal precautions, they should be able to tell you when you no longer need to follow the precautions. In general, your breastbone should be healed within about four to six weeks following your open heart surgery, and sternal precautions should be lifted at that time.
Again, follow the advice of your healthcare provider regarding when to stop following sternal precautions. There is some debate as to whether sternal precautions are absolutely necessary to protect your breastbone as it heals after open heart surgery.
There is a lack of evidence that indicates you are in danger if you do not follow sternal precautions, and some healthcare providers may recommend performing normal activities based on your own tolerance. An echocardiogram test uses sound waves to produce live images of your heart.
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Researchers say olive oil, as well as certain vegetable oils, are healthier for your heart than animal-based fats. Leigh Pechillo is a heart attack survivor. In this letter, she writes about when she had the heart attack, what it was like, and the recovery process. Health Conditions Discover Plan Connect. Sternal Precautions. Medically reviewed by William Morrison, M. Examples Physical therapy How long do they last? Takeaway What are sternal precautions?
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