Sternal precautions after cardiac surgery
If you, or someone you know, has ever had heart surgery, the surgeon may have accessed the heart by cutting the sternum vertically down the midline and spreading it apart. Afterwards, the 2 halves of the sternum are wired shut to encourage the cut halves of the sternum to stay pushed closely together while they heal.
This was probably followed up with advice to limit movements of the trunk and limbs to protect their sternum while it heals. To a large extent, these 'sternal precautions' were based on a fine logical argument but - like so many things we think we understand in the human body - it is always better to test such ideas to be sure they work as anticipated.
To investigate whether modifying usual sternal precautions to make them less restrictive improves outcomes in people who had undergone cardiac surgery, this RCT allocated 70 participants:
- either to receive the traditional, restrictive sternal precautions (don't raise the arms above 90 degrees, don't lift objects more than 2 kg, don't put your hand behind your back to tuck your shirt in, don't push off the arm-rests of a chair when standing up, etc);
- or to less-restrictive advice to use the arms within pain limits.
Surprisingly, the 2 sets of sternal precautions didn't produce differences in the number of sternal complications, nor in how well the patients could function physically 4 and 12 weeks after the surgery. Pain, fear of movement, and quality of life also did not differ signficantly between the groups.
The between-group differences had quite narrow confidence intervals, suggesting that the lack of difference in outcomes between the groups is real and not merely due to lack of statistical power.
This suggests that strict sternal precautions may not be necessary. Advice to be guided by pain would certainly be a more convenient regimen for patients to follow.
Although further research will be conducted, this study may mark the begining of the end for strict sternal precautions after cardiac surgery.
Want to read deeper into this topic? Have a look at the free full text version of this article published in Journal of Physiotherapy!
> From: Katijjahbe et al., J Physiother 64 (2018) 97-106. All rights reserved to the Australian Physiotherapy Association. Click here for the online summary.