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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 MA 1 , Granger CL 2 , Denehy L 3 , Royse A 4 , Royse C 5 , Bates R 6 Show all authors , Logie S 7 , Nur Ayub MA 8 , Clarke S 9 , El-Ansary D 10

Affiliations 

  • 1 Department of Physiotherapy, The University of Melbourne, Australia; Department of Physiotherapy, Hospital Canselor Tunku Mukhriz, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
  • 2 Department of Physiotherapy, The University of Melbourne, Australia; Physiotherapy Department, Royal Melbourne Hospital, Australia
  • 3 Department of Physiotherapy, The University of Melbourne, Australia
  • 4 Department of Surgery, The University of Melbourne, Australia; Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Australia
  • 5 Department of Surgery, The University of Melbourne, Australia; Department of Anaesthesia, Royal Melbourne Hospital, Australia
  • 6 Physiotherapy Department, Royal Melbourne Hospital, Australia
  • 7 Physiotherapy Department, Melbourne Private Hospital, Australia
  • 8 Heart and Lung Centre, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
  • 9 Statistical Consulting Centre, School of Mathematics and Statistics, The University of Melbourne, Australia
  • 10 Department of Physiotherapy, The University of Melbourne, Australia; Department of Surgery, The University of Melbourne, Australia; Department of Health Professions, Swinburne University, Melbourne, Australia
J Physiother, 2018 04;64(2):97-106.
PMID: 29602750 DOI: 10.1016/j.jphys.2018.02.013

Abstract

QUESTION: In people who have undergone cardiac surgery via median sternotomy, does modifying usual sternal precautions to make them less restrictive improve physical function, pain, kinesiophobia and health-related quality of life?

DESIGN: Two-centre, randomised, controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis.

PARTICIPANTS: Seventy-two adults who had undergone cardiac surgery via a median sternotomy were included.

INTERVENTION: Participants were randomly allocated to one of two groups at 4 (SD 1) days after surgery. The control group received the usual advice to restrict their upper limb use for 4 to 6 weeks (ie, restrictive sternal precautions). The experimental group received advice to use pain and discomfort as the safe limits for their upper limb use during daily activities (ie, less restrictive precautions) for the same period. Both groups received postoperative individualised education in hospital and via weekly telephone calls for 6 weeks.

OUTCOME MEASURES: The primary outcome was physical function assessed by the Short Physical Performance Battery. Secondary outcomes included upper limb function, pain, kinesophobia, and health-related quality of life. Outcomes were measured before hospital discharge and at 4 and 12 weeks postoperatively. Adherence to sternal precautions was recorded.

RESULTS: There were no statistically significant differences in physical function between the groups at 4 weeks (MD 1.0, 95% CI -0.2 to 2.3) and 12 weeks (MD 0.4, 95% CI -0.9 to 1.6) postoperatively. There were no statistically significant between-group differences in secondary outcomes.

CONCLUSION: Modified (ie, less restrictive) sternal precautions for people following cardiac surgery had similar effects on physical recovery, pain and health-related quality of life as usual restrictive sternal precautions. Similar outcomes can be anticipated regardless of whether people following cardiac surgery are managed with traditional or modified sternal precautions.

TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ANZCTRN12615000968572. [Katijjahbe MA, Granger CL, Denehy L, Royse A, Royse C, Bates R, Logie S, Nur Ayub MA, Clarke S, El-Ansary D (2018) Standard restrictive sternal precautions and modified sternal precautions had similar effects in people after cardiac surgery via median sternotomy ('SMART' Trial): a randomised trial. Journal of Physiotherapy 64: 97-106].

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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