Article

Following cardiac surgery via median sternotomy, patients are routinely
advised to adhere to upper limb restrictions to prevent the development of
sternal complications. However, there is no definitive evidence to support the
clinical application of such restrictions. The purpose of this study was to
investigate current physiotherapy practice regarding upper limb exercise
guidelines for this population, within outpatient cardiac rehabilitation in
Australia. METHODS: Physiotherapists working within outpatient cardiac
rehabilitation programs in Australia were invited to complete a Web survey.
RESULTS: The response rate was 77%. The majority of respondents (96%) prescribed
upper limb exercises to patients following median sternotomy, with 95% placing
restrictions on these exercises. At 6 weeks postoperatively, 58% and 73% of
respondents still placed restrictions on unloaded and loaded unilateral upper
limb elevation exercises respectively; similarly, 55% and 74% placed restrictions
on unloaded and loaded bilateral upper limb elevation exercises, respectively.
However, there was a lack of consensus on the type and timing of these
restrictions, with patient-reported pain being the main parameter used to guide
upper limb exercise prescription and progression. Only 43% reported screening for
sternal instability, and if detected, the majority based their management on
clinical experience. CONCLUSIONS: There is significant variation in practice with
respect to the prescription and progression of upper limb exercises, within
outpatient cardiac rehabilitation in Australia. Further research is warranted to
establish evidence-based guidelines for the upper limb rehabilitation of patients
following cardiac surgery via median sternotomy.

Langue : ANGLAIS