RESEARCH REPORT POSTER DISPLAY

CLINICAL PRACTICE GUIDELINE FOR THE PHYSIOTHERAPY MANAGEMENT OF ADULTS UNDERGOING CARDIAC SURGERY. Anderson C¹, Overend T², Jackson J¹, Lucy S², Prendergast M¹, Sinclair S¹; ¹London Health Sciences Centre, London, Ontario, Canada. ²University of Western Ontario, London, Ontario, Canada

PURPOSE: To develop a clinical practice guideline (CPG) for the optimal perioperative physiotherapy management of adult patients undergoing cardiac surgery. RELEVANCE: There are conflicting reports in the literature with respect to the physiotherapeutic intervention necessary for patients undergoing cardiac surgery. Ensuring an evidence-based approach to the care of these patients is vital in moving the profession of physiotherapy forward. PARTICIPANTS: This CPG was developed for adults undergoing cardiac surgery, including coronary artery bypass graft(s) and/or valvular surgery and a sternotomy. METHODS: A systematic review was conducted. Medline, CINAHL and EMBASE databases were searched from inception to Aug 2006. Key terms included physiotherapy, cardiac surgery, coronary artery bypass, valve surgery, postoperative complications, atelectasis, breathing exercises, mobility and education. A secondary search of the retrieved articles was also performed. Each study was independently appraised by two reviewers using a standardized tool, who then reached consensus before presenting to the research team for final agreement. Papers were graded for level of evidence and summarized in recommendations. Evidence was not available in all areas of practice, thus a survey was conducted of a representative sample (n=18) of hospitals performing cardiac surgery in Canada to ascertain current practice. Survey questions examined cardiorespiratory care, mobility treatment, exercises and education provided for patients undergoing cardiac surgery requiring routine care. This information was used to help fill in the gaps in the systematic review. ANALYSIS: Seventy-five of the 139 articles retrieved were critically appraised, of which 35 were rejected for methodological flaws. Evidence-based recommendations were extracted from 38 papers. Seventeen of the 18 Canadian sites participated in the telephone interview to determine current practice. One site provided written responses. RESULTS: The literature dealt with low-risk patients only. Twelve grade A recommendations, dealing with cardiorespiratory physiotherapy, education, prehabilitation and pain were identified for patients requiring routine care following cardiac surgery. Survey information for mobility, and upper and lower extremity exercise was incorporated into the guideline to address the gaps in the evidence. CONCLUSIONS: Ensuring assistance with mobilization and education regarding breathing exercises and other self-treatments during the postoperative course are the key and perhaps only components required in patients undergoing cardiac surgery requiring routine care. The evidence does not support some traditional cardiorespiratory techniques such as sustained maximal inspiration and single-handed percussion. Survey results showed that while Canadian physiotherapists practice early ambulation and education, some continue to provide cardiorespiratory techniques that are not supported by the evidence. Further research is needed to address the gaps in the literature. IMPLICATIONS: This guideline will help to facilitate evidence-based practice with adult patients requiring routine care following cardiac surgery. KEYWORDS: Clinical Practice Guideline. FUNDING ACKNOWLEDGEMENTS: London Health Sciences Centre Physiotherapy Research Seed Fund. CONTACT: cathy.anderson@lhsc.on.ca