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| Name | Class |
|---|---|
| University of Sao Paulo | OTHER |
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Sternal instability caused by mediastinitis is one of the most feared complications for cardiac surgery team for generating large commitments and functional damages to patients. Biomechanically, the contraction of abdominal muscles such as transverse abdominal, produces forces that result in a "corset-like" action and anterior thoracic cage muscles too may assist in stabilizing the sternum. Thus, strengthening the abdominal muscles might contribute to the recovery of functional aspects. The aim was to evaluate whether contraction and strengthening the abdominal muscles could improve lung function and respiratory muscle strength in patients with sternal instability.
Sternal instability was confirmed by physical examination and confirmed by chest tomography. The data were collected before and after the 3-week period of intervention.
Sternal instability way assessed by the unstable sternal scale, graduated from zero to 4 points.
The respiratory muscle strength was measured through Manuvacuometry and the pulmonary function by the spirometry.
Pain was recorded by using a Visual Analog Scale (0 -10); Discomfort Scale( 0-10) and Identification of Activities that cause pain and discomfort.
Patients underwent abdominal exercise protocol for three weeks once a day, lasting about 15 minutes followed by the physiotherapist.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Physiotherapy exercises | Experimental | Two strategies of abdominal exercises with and without movement of the upper limbs applied in patients with sternal instability as randomization. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| physiotherapy exercises | Other | Consisted of trunk stabilization exercises.The exercises were undertaken for 15 minutes every day for tree weeks. Patients were the contract their abdominal muscles with an emphasis on the transverse abdominal. Patients were to contract their abdominal muscles in a supine,sitting and stand up position. |
| Measure | Description | Time Frame |
|---|---|---|
| Improvement of pulmonary function | Measure of maximal muscles respiratory pressures and spirometry tests | 3 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Measure of pain on the Visual Analog Scale | Pain Visual Analog Scale | 3 weeks |
| Discomfort - using Discomfort Scale | Activities using Discomfort Scale |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| EMILIA NOZAWA, PHD | University of Sao Paulo | Principal Investigator |
| Patricia O Almeida, PT | HEART INSTITUTE (INCOR) HOSPITAL DAS CLINICAS | Study Chair |
| Ludhmila A Hajjar, PHD | University of Sao Paulo | Study Chair |
| Filomena G Gallas, PHD | University of Sao Paulo | Study Chair |
| Cristiane D Goncalves, FT | HEART INSTITUTE (INCOR) HOSPITAL DAS CLINICAS | Study Chair |
| Maria Ignez Z Feltrim, PHD | University of Sao Paulo | Study Director |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18760163 | Result | El-Ansary D, Waddington G, Adams R. Control of separation in sternal instability by supportive devices: a comparison of an adjustable fastening brace, compression garment, and sports tape. Arch Phys Med Rehabil. 2008 Sep;89(9):1775-81. doi: 10.1016/j.apmr.2008.01.025. | |
| 17934967 | Result | El-Ansary D, Waddington G, Adams R. Relationship between pain and upper limb movement in patients with chronic sternal instability following cardiac surgery. Physiother Theory Pract. 2007 Sep-Oct;23(5):273-80. doi: 10.1080/09593980701209402. |
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| ID | Term |
|---|---|
| D008480 | Mediastinitis |
| D003324 | Coronary Artery Disease |
| D053821 | Cardiovascular Infections |
| ID | Term |
|---|---|
| D008477 | Mediastinal Diseases |
| D013896 | Thoracic Diseases |
| D012140 | Respiratory Tract Diseases |
| D003327 | Coronary Disease |
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|
| 3 weeks |
| 18047460 | Result | El-Ansary D, Waddington G, Adams R. Trunk stabilisation exercises reduce sternal separation in chronic sternal instability after cardiac surgery: a randomised cross-over trial. Aust J Physiother. 2007;53(4):255-60. doi: 10.1016/s0004-9514(07)70006-5. |
| 19272785 | Result | Gorlitzer M, Folkmann S, Meinhart J, Poslussny P, Thalmann M, Weiss G, Bijak M, Grabenwoeger M. A newly designed thorax support vest prevents sternum instability after median sternotomy. Eur J Cardiothorac Surg. 2009 Aug;36(2):335-9; discussion 339. doi: 10.1016/j.ejcts.2009.01.038. Epub 2009 Mar 9. |
| 21529357 | Result | Fawzy H, Osei-Tutu K, Errett L, Latter D, Bonneau D, Musgrave M, Mahoney J. Sternal plate fixation for sternal wound reconstruction: initial experience (retrospective study). J Cardiothorac Surg. 2011 Apr 29;6:63. doi: 10.1186/1749-8090-6-63. |
| 19303579 | Result | Lepelletier D, Poupelin L, Corvec S, Bourigault C, Bizouarn P, Blanloeil Y, Reynaud A, Duveau D, Despins P. Risk factors for mortality in patients with mediastinitis after cardiac surgery. Arch Cardiovasc Dis. 2009 Feb;102(2):119-25. doi: 10.1016/j.acvd.2008.11.003. Epub 2009 Feb 3. |
| 16305872 | Result | Cowan KN, Teague L, Sue SC, Mahoney JL. Vacuum-assisted wound closure of deep sternal infections in high-risk patients after cardiac surgery. Ann Thorac Surg. 2005 Dec;80(6):2205-12. doi: 10.1016/j.athoracsur.2005.04.005. |
| 20625667 | Result | Costa D, Goncalves HA, Lima LP, Ike D, Cancelliero KM, Montebelo MI. New reference values for maximal respiratory pressures in the Brazilian population. J Bras Pneumol. 2010 May-Jun;36(3):306-12. doi: 10.1590/s1806-37132010000300007. English, Portuguese. |
| 13129420 | Result | Sakamoto H, Fukuda I, Oosaka M, Nakata H. Risk factors and treatment of deep sternal wound infection after cardiac operation. Ann Thorac Cardiovasc Surg. 2003 Aug;9(4):226-32. |
| 17768574 | Result | Gelape CL. Surgical wound infection following heart surgery. Arq Bras Cardiol. 2007 Jul;89(1):e3-9. doi: 10.1590/s0066-782x2007001300013. No abstract available. English, Portuguese. |
| 16055882 | Result | Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J; ATS/ERS Task Force. Standardisation of spirometry. Eur Respir J. 2005 Aug;26(2):319-38. doi: 10.1183/09031936.05.00034805. No abstract available. |
| D017202 |
| Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D001161 | Arteriosclerosis |
| D001157 | Arterial Occlusive Diseases |
| D014652 | Vascular Diseases |
| D007239 | Infections |