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Effect of Adding Integrated Core and Graduated Upper Limb Exercises to Inpatient Cardiac Rehabilitation on Sternal
Sherin Hassan Mohammed Mehani1, Zeinab Mohammed Helmy2, Heba Mohammed Ali1
1Physical Therapy Department for Cardiovascular / Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Beni-Suef University.
Insights
Adding core and upper limb exercises to cardiac rehabilitation significantly improved sternal healing and reduced pain in patients after coronary artery bypass grafting (CABG). This intervention also enhanced daily living activities for improved recovery.
Area of Science:
- Cardiovascular Surgery
- Rehabilitation Medicine
- Orthopedics
Background:
- Sternal instability is a complication following coronary artery bypass grafting (CABG).
- Inpatient cardiac rehabilitation is crucial for post-CABG recovery.
- Optimizing rehabilitation protocols can improve patient outcomes.
Purpose of the Study:
- To assess the impact of integrated core and graduated upper limb exercises on sternal instability post-CABG.
- To evaluate the effect of this exercise regimen on pain and activities of daily living (ADL).
Main Methods:
- A randomized controlled trial involving 40 patients with post-CABG sternal instability.
- Intervention group received standard rehabilitation plus targeted exercises; control group received standard rehabilitation only.
- Sternal separation (ultrasonography), pain (visual analog scale), and ADL index were measured.
Main Results:
- The intervention group demonstrated significantly reduced sternal separation compared to the control group.
- Both groups experienced pain reduction, but the intervention group showed greater improvement in ADL scores.
- Significant interaction between time and group effects was observed (P=.0001).
Conclusions:
- Integrated core and graduated upper limb exercises enhance sternal healing in post-CABG patients with sternal instability.
- This exercise approach effectively reduces pain and improves functional recovery (ADL).
- The findings support incorporating these specific exercises into inpatient cardiac rehabilitation programs.
Objective:
To evaluate the effect of adding integrated core and graduated resistance upper limb exercises to an inpatient cardiac rehabilitation program in patients with acute sternal instability after coronary artery bypass grafting (CABG).
Design:
This was a single-center, randomized, controlled, parallel-group intervention study.
Setting:
This study was conducted at the National Heart Institute.
Participants:
Forty patients with post-CABG with sternal instability aged 50-60 years completed this study and were randomized into 2 groups: an intervention group (n=20) and an active control group (n=20).
Intervention:
The intervention group (A) received a routine inpatient rehabilitation program from the first postoperative day plus integrated core and graduated resistance upper limb exercises, which started from the seventh postoperative day for approximately 4 weeks, whereas the control group (B) received only the routine inpatient rehabilitation program.
Main Outcome Measures:
Sternal separation measured by ultrasonography, visual analog scale for measuring pain, and activities of daily living (ADL) index were main outcome measures.
Results:
Patients in the intervention group (A) showed a significant reduction in sternal separation from the supine and long sitting positions, whereas those in the control group (B) showed a significant increase in sternal separation (P=.0001). Both groups showed a reduction in pain, and an increase in the ADL score was observed in group A. There was a significant interaction between the time and group effects (P=.0001).
Conclusion:
Adding integrated core and graduated upper limb exercises to inpatient cardiac rehabilitation for patients with sternal instability after coronary artery bypass grafting significantly improved sternal healing, pain, and ADL.
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