Implementing Evidence to Inform Recovery After Cardiac Surgery via Median Sternotomy Is Feasible and Effective Using...

After cardiac surgery including median sternotomy, patients are often advised to restrict upper limb activity, lifting, and weight bearing to reduce the risk of wound dehiscence and sternal instability. "Keep Your Move in the Tube" (KMIT) is an evidence-based strategy developed for patients after a sternotomy for cardiac surgery that promotes early resumption of functional activities using biomechanical principles. To date, there is inconsistency of KMIT implementation to improve patient recovery and outcomes. The application of a knowledge translation approach may facilitate the transformation in practice required. The aims of this study were to conduct a review of current practice, with a focus on exercise for patients after median sternotomy in public acute surgical and cardiac rehabilitation programs in Australia and assess the implementation of KMIT using the Knowledge to Action framework.

This prospective, longitudinal, observational study used a RE-AIM framework for assessment. The project was undertaken in four main phases; i) a survey to assess cardiac rehabilitation practice, ii) development and codesign of an implementation strategy to standardise education and exercise training, iii) implementation, and iv) assessment of the implementation strategy between December 2021 and June 2024.

The survey found lifting and weight bearing advice and exercise provided to patients after a sternotomy for cardiac surgery was inconsistent across the included cardiac rehabilitation programs. The results of the education delivered by 12 local change champions and attended by 390 clinicians demonstrated an improvement in KMIT familiarity from 11% to 76%. A total of 82% reported integrating KMIT principles into usual clinical practice, an increase from 23% at baseline. At follow-up, 82% of respondents reported that KMIT was embedded as clinical practice. Despite a comprehensive education and training strategy, a systematic implementation using a structured framework and high levels of adoption, uncertainty remained about load and time restrictions after a sternotomy, highlighting a need for strategies which focus on the key principles of KMIT and their implications for functional tasks and exercise.

Using a structured process to codesign, develop, and implement a bespoke education and training intervention, KMIT was successfully adopted across cardiac rehabilitation programs within a large health service. This study has also identified opportunities for future improvements and strategies to promote consistency translation and sustainability.