Physical Therapy Management for Adult Patients Undergoing Cardiac Surgery: A Canadian Practice Survey
ABSTRACT
ABSTRACT
Purpose: To determine current Canadian physical therapy practice for adult patients requiring routine care following cardiac surgery.
Methods: A telephone survey was conducted of a selected sample (n=18) of Canadian hospitals performing cardiac surgery to determine cardiorespiratory care, mobility, exercises, and education provided to patients undergoing cardiac surgery.
Results: An average of 21 cardiac surgeries per week (range: 6–42) were performed, with an average length of stay of 6.4 days (range: 4.0–10.6). Patients were seen preoperatively at 7 of 18 sites and on postoperative day 1 (POD-1) at 16 of 18 sites. On POD-1, 16 sites performed deep breathing and coughing, 7 used incentive spirometers, 13 did upper-extremity exercises, and 12 did lower-extremity exercises. Nine sites provided cardiorespiratory treatment on POD-3. On POD-1, patients were dangled at 17 sites and mobilized out of bed at 13. By POD-3, patients ambulated 50–120 m per session 2–5 times per day. Sternal precautions were variable, but the lifting limit was reported as ranging between 5 lb and 10 lb.
Conclusions: Canadian physical therapists reported the provision of cardiorespiratory treatment after POD-1. According to current available evidence, this level of care may be unnecessary for uncomplicated patients following cardiac surgery. In addition, some sites provide cardiorespiratory treatment techniques that are not supported by evidence in the literature. Further research is required.
RÉSUMÉ
Objectif : Établir en quoi consiste la pratique actuelle en physiothérapie au Canada pour les patients adultes qui ont besoin de soins intermédiaires à la suite d'une chirurgie cardiaque.
Méthodes : Un sondage téléphonique a été réalisé auprès d'un échantillon choisi d'hôpitaux canadiens (n=18) afin de répertorier les soins cardiorespiratoires et pour la mobilité, les exercices et la réadaptation offerts aux patients qui subissent une chirurgie cardiaque.
Résultats : En moyenne, 21 chirurgies cardiaques par semaine (entre 6 et 42 interventions) ont été pratiquées dans les établissements sondés et ces interventions ont occasionné des séjours à l'hôpital d'une moyenne de 6,4 jours (de 4,0 à 10,6 jours par établissement). Les patients étaient vus de façon proactive dans 7 des 18 hôpitaux sondés et au premier jour de la période postopératoire (JPP-1) dans 16 des 18 hôpitaux. Au JPP-1, 16 établissements ont demandé au patient de prendre de grandes respirations et de tousser, 7 ont utilisé des spiromètres incitatifs, 13 ont procédé à des exercices des membres supérieures et 12 à des exercices des membres inférieurs. Neuf sites ont offert des soins cardiorespiratoires au jour 3. Au jour 1, les patients étaient aidés à s'asseoir et à se redresser dans 17 hôpitaux, et mobilisés hors de leur lit dans 13 établissements. Au jour 3 après l'intervention, les patients marchaient de 50 à 120 m, de 2 à 5 fois par jour. Les mesures de précautions sternales variaient selon les cas, mais la limite de charge décrite se chiffrait à entre 2,27 et 4,54 kg (entre 5 et 10 lb).
Conclusions : Les physiothérapeutes canadiens font état de prestation de soins cardiorespiratoires après le JPP-1. Selon les données probantes actuellement disponibles, ce niveau de soins pourrait ne pas être nécessaire pour les patients sans complications après une chirurgie cardiaque. De plus, certains hôpitaux ont recours à des techniques de soins cardiorespiratoires qui ne sont pas appuyés sur des faits scientifiques documentés. Des recherches plus poussées sont nécessaires.
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Published In
Physiotherapy Canada
Volume 62 • Number 3 • Summer 2010
Pages: 215 - 221
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© Canadian Physiotherapy Association, 2010. All rights reserved.
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Published in print: Summer 2010
Published online: 23 July 2010
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Overend TJ, Anderson CM, Jackson J, Lucy SD, Prendergast M, Sinclair S. Physical therapy management for adult patients undergoing cardiac surgery: a Canadian practice survey. Physiother Can. 2010;62:215–221.
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Physiotherapy Canada 2010 62:3, 215-221
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