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.
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.
Authors: Jenny Adams; Ana Lotshaw; Emelia Exum; Mark Campbell; Cathy B Spranger; Jim Beveridge; Shawn Baker; Stephanie McCray; Tim Bilbrey; Tiffany Shock; Anne Lawrence; Baron L Hamman; Jeffrey M Schussler Journal: Proc (Bayl Univ Med Cent) Date: 2016-01
Authors: Md Ali Katijjahbe; Linda Denehy; Catherine L Granger; Alistair Royse; Colin Royse; Rebecca Bates; Sarah Logie; Sandy Clarke; Doa El-Ansary Journal: Trials Date: 2017-06-23 Impact factor: 2.279