Two local hospitals were amalgamating cardiac surgery services. There was a disparity in the perioperative physiotherapy care provided following cardiac surgery at the two sites. Thus our purpose was to carry out a systematic review of the evidence to determine the optimal perioperative physiotherapy management of cardiac surgery patients following CABG and/or cardiac valve surgery.
Medline, CINAHL and EMBASE data bases were searched from inception until April 2005, using key terms including physiotherapy, coronary artery bypass, cardiac surgery, valve surgery, postoperative complications, atelectasis, breathing exercises, mobility, and education. A secondary search of the reference lists of all identified articles was also carried out. A form was developed to standardize critical appraisal. Each study was reviewed independently by one of three pairs of reviewers. The pair then met to reach consensus before presenting the study to the entire research team for final agreement. Accepted papers were graded for strength of evidence and recommendations were extracted for physiotherapy practice.
The search strategy yielded 138 articles. Seventy-four studies dealing with physiotherapy management of the CABG and/or cardiac valve surgery patient in the perioperative period were accepted and critically appraised; 33 of these were rejected for methodological flaws. Evidence-based conclusions relating to physiotherapy practice were extracted from 37 papers and combined into 13 recommendations: perioperative cardiorespiratory therapy (5), education (6), anxiety (1) and pain control (1). There was insufficient evidence to support recommendations for exercise, positioning, shoulder range of motion, and acute effects of cardiorespiratory treatment in the perioperative period.
Virtually all of the reviewed literature dealt with low-risk patients. High-risk cardiac surgery patients thus require individually determined, perioperative physiotherapy management. While perioperative education and mobility remain important for routine patients, the evidence does not support other traditional postoperative cardiorespiratory physiotherapy treatment approaches.
The routine, low-risk cardiac surgery patient requires little in the way of perioperative cardiorespiratory physiotherapy save for ensuring initial mobility assistance and provision of education regarding breathing exercises and other self-treatments during the postoperative course.
Tom Overend, None.