Trends in cardiac surgery: exploring the past and looking into the future

Multimedia Exercise Training Program Improves Distance Walked, Heart Rate Recovery, and Self-efficacy in Cardiac Surgery Patients

BACKGROUND

Patient education has been shown to be more effective when delivered using multimedia than written materials. However, the effects of using multimedia to assist patients in cardiac rehabilitation have not been investigated.

OBJECTIVE

The purpose of this study is to examine the effect of an inpatient multimedia exercise training program on distance walked in the 6-minute walking test (6MWT), heart rate recovery, and walking self-efficacy of patients who had undergone heart surgery.

METHODS

For this longitudinal quasi-experimental study, 60 consecutive patients were assigned to an experimental (n = 20; inpatient multimedia exercise training program) or control (n = 40; routine care) group. Data were collected at 3 times (before surgery, 1 to 2 days before hospital discharge, and 1 month after hospital discharge) and analyzed with the generalized estimating equation approach.

RESULTS

Most subjects were men (66.7%), had a mean age of 61.32 ± 13.4 years and left ventricular ejection fraction of 56.96% ± 13.28%, and underwent coronary artery bypass graft surgery (n = 34, 56.7%). Subjects receiving the exercise training program showed significantly greater improvement than those in the control group in the 6MWT walking distance (P < .001), heart rate recovery (P = .04), and self-efficacy (P = .002) at hospital discharge. Furthermore, the intervention effects on 6MWT distance (P < .001) and self-efficacy (P < .001) were sustained at 1 month after hospital discharge.

CONCLUSION

Our inpatient multimedia exercise training program safely improved distance walked in the 6MWT, heart rate recovery, and self-efficacy at hospital discharge in patients after heart surgery and maintained their improvement in 6MWT and self-efficacy 1 month later.

Effects of a preoperative individualized exercise program on selected recovery variables for cardiac surgery patients: A pilot study

OBJECTIVE

Research on preoperative individualized exercise prescription (PIEP) for heart surgery patients in Taiwan is lacking. Thus, the purpose of this study was to examine the feasibility of a PIEP in the Taiwanese population.

METHOD

A quasi-experimental design, using purposive sampling, was conducted. Thirty-five patients were recruited, of whom 15 chose to participate in the experimental (PIEP training plus usual care) group, and 20 chose to participate in the control (usual care) group. The effects of the intervention were determined by pulmonary complication-related parameters and quality of life.

RESULTS AND CONCLUSION

The development and process of PIEPs suitable for cardiac patients was described in this study. The results reveal that the two-week exercise-training program contributed to a decreased peak respiratory exchange ratio (RER) after the surgery and earlier ambulation. The effectiveness of PIEPs in improving the quality of life in cardiac surgery patients was validated. This study may also contribute as a reference of the PIEP effect on patients to the healthcare providers.

Management of sternal precautions following median sternotomy by physical therapists in Australia: a web-based survey

BACKGROUND

Sternal precautions are utilized within many hospitals with the aim of preventing the occurrence of sternal complications (eg, infection, wound breakdown) following midline sternotomy. The evidence base for sternal precaution protocols, however, has been questioned due to a paucity of research, unknown effect on patient outcomes, and possible discrepancies in pattern of use among institutions.

OBJECTIVE

The objective of this study was to investigate and document the use of sternal precautions by physical therapists in the treatment of patients following median sternotomy in hospitals throughout Australia, from immediately postsurgery to discharge from the hospital.

DESIGN

A cross-sectional, observational design was used. An anonymous, Web-based survey was custom designed for use in the study.

METHODS

The questionnaire was content validated, and the online functionality was assessed. The senior cardiothoracic physical therapist from each hospital identified as currently performing cardiothoracic surgery (N=51) was invited to participate.

RESULTS

The response rate was 58.8% (n=30). Both public (n=18) and private (n=12) hospitals in all states of Australia were represented. Management protocols reported by participants included wound support (n=22), restrictions on lifting and transfers (n=23), and restrictions on mobility aid use (n=15). Factors influencing clinical practice most commonly included "workplace practices/protocols" (n=27) and "clinical experience" (n=22). Limitations The study may be limited by response bias.

CONCLUSIONS

Significant variation exists in the sternal precautions and protocols used in the treatment of patients following median sternotomy in Australian hospitals. Further research is needed to investigate whether the restrictions and precautions used are necessary and whether protocols have an impact on patient outcomes, including rates of recovery and length of stay.