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| NO secondary ID | Other Identifier | NO secondary ID |
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the aim of this study is to find out the differences between the effect of supra- abdomen exercises and the effect of infra-abdomen exercise combined with LASER And the effect of LOW LEVEL LASER only on sternal instability. Methods: 120 patients of both sexes who had acute sternal instability post-open heart surgery will be recruited in this study at Assiout University Hospitals; their ages will be > 18 years. They will be randomly assigned into 4 equal groups:
Type of study: Randomized controlled trial This study is a prospective interventional study one that will be conducted on 120 patients of both sexes who had acute sternal instability post-open heart surgery; their ages will be < 18 years. They will be recruited from Assiut University Hospitals and will randomly be divided into 4 equal groups
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group A: Supra-abdominal + LLL | Experimental | Participants in this group receive a combined intervention in addition to the standard cardiac rehabilitation program during phase I |
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| Group B: Infra-abdominal + LLL | Experimental | Participants in this group receive a combined intervention in addition to the standard cardiac rehabilitation program during phase I. |
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| Group C: LLL Only | Experimental | Participants in this group receive low-level laser therapy in addition to the standard cardiac rehabilitation program during phase I. |
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| Group D: Control | Experimental | Participants in this group receive the standard cardiac rehabilitation program during phase I. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| supra abdomen resisted exercises combined with LLL + Traditional cardiac rehabilitation program of phase one | Behavioral | Ex 1:- Sitting In Erect Position + Breathing For 3 Min And Repeat 2 Times {Neutral Spine } Ex 2:- Hands On Lower Costal + Inhale Maximally For 5 Sec, Exhale Slowly With Abdominal Muscle Contract And Repeat 10 Times {Thoracic Expansion } Ex 3 :- Hands On Iliac Crest Deep Inhalation + Slow Exhalation For 5 Sec + Contraction Of Abdominal Muscle With Hands Closing At The Hip {Abdominal } Ex 4 :- Inhale Rotate The Trunk To Opposite Side Of Resistance Given By PT + Exhale + Contract Abdominal Muscle { Abdominal Ex With Trunk Rotation } Ex 5:- Cross Arm On Upper Thorax Inhale Raising + Exhale + Contract + While Expiration, Incline Trunk To Opposite Of Resistance Repeat 5 Times For Each Arm Separately Ex6:- Inhale + Raising Two Arm To Shoulder Level With Extended Elbow + Exhale + Contract 5 Sec {Arm - Trunk Dissociation } Repeat 10 Times Ex 7:- Inhale + Flex Arm With Extension Elbow + Exhale + Contract And Return Arm {Alternate Trunk And Shoulder Dissociatio |
| Measure | Description | Time Frame |
|---|---|---|
| sternal instability |
| at baseline and after finishing program (up to one month) |
| Measure | Description | Time Frame |
|---|---|---|
| Functional Impairment Scale: | 1)Functional Impairment Scale: Functional impairment was based on a numerical scale from 0 to 10, as follows: 0-3, did not interfere with activities; 4-6, interfered but did not prevent activities; 7-9, prevented activities; and 10, prevented activities and/or caused lack of control Higher scores indicate greater functional impairment. | at baseline and after finishing program (up to one month) |
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IInclusion criteria :
All included patients will be:
Exclusion criteria:
Patient will be excluded if:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mayar Mohammed Khalifa Ahmed Ahmed, master | Contact | 01091103744 | mayarmora02@gmail.com | |
| MAHMOUD IBRAHIM MOHAMED MOHAMED, lecture | Contact | +201142998414 | Mahmoud.ibrahim@pt.bsu.edu.eg |
| Name | Affiliation | Role |
|---|---|---|
| SHERIN HASSAN MOHAMMED MEHANI. MEHANI., professor | benisueif university | Principal Investigator |
| MOHAMMED AHMED KHALIL SALAMA SALAMA, professor | Assiut University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| مستشفي القلب الحامعي -مستشفيات جامعه اسيوط | Asyut | Egypt |
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| ): patients will infra abdomen resisted exercises combined with LLL +Traditional cardiac rehabilitation program of phase one. | Behavioral | Ex 1:- Sitting In Erect Position + Breathing For 3 MinAnd Repeat 2 Times Ex 2:- Hands On Lower Costal + Inhale Maximally For 5 Sec, Exhale Slowly With Abdominal Muscle Contract And Repeat 10 Times Ex 3 :- Hands On Iliac Crest Deep Inhalation + Slow Exhalation For 5 Sec + Contraction Of Abdominal Muscle With Hands Closing At The Hip Ex 4 :- Inhale Rotate The Trunk To Opposite Side Of Resistance Given By PT + Exhale + Contract Abdominal Muscle Ex 5:- Cross Arm On Upper Thorax Inhale Raising + Exhale + Contract + While Expiration, Incline Trunk To Opposite Of Resistance Repeat 5 Times For Each Arm Separately Ex 6 :- Inhale + Raise Knee With Flexed Hip + Expiration + Contract Ex 7: Inhale + Exhale + Adducting Hip And Knees + Contract Ex 8 :- Inhale + Raise One Knee + Exhale+Contract+Trunk Rotation To The Side Of Raised Leg |
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| patients will receive Traditional cardiac rehabilitation program of phase one with LLL | Behavioral | A probe laser device will be usedat median sternotomy site. at a distance of 2 cm from each other, for a total of five to eight points. the device will be placed in a perpendicular position to the sternum each spot for 60 sec for a total session time of 5-10 min. Each patient will receive one session daily, three times a week, for four consecutive weeks:•Treatment time per point (s) 60•Laser beam Class :3B•Laser Type :Semiconductor GaA.Modes of Operation :Continuous Pulse upto 5 khz.•Wave Length: 685nm•Maximum Probe Power: 500 mw•Power Density:0.8w/cm2•Max Energy within 1 min 2.4 Joules•Number of spots 8 Patients will be instructed to perform deep breathing using incentive spirometry in the form of four sets, each consisting of 10 deep breaths for a total of 40 deep breaths, with a hold at the end of inspiration, then huffs and coughs with the support of pillows at the incision. The patients will be instructed to follow sternal precautions |
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| patients will receive Traditional cardiac rehabilitation program of phase one only | Other | Patients will be instructed to perform deep breathing using incentive spirometry in the form of four sets, each consisting of 10 deep breaths for a total of 40 deep breaths, with a hold at the end of inspiration, then huffs and coughs with the support of pillows at the incision. The patients will be instructed to follow sternal precautions |
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| pain assessment | Pain intensity will be measured using the Visual Analog Scale (VAS), a 10-cm horizontal line ranging from 0 to 10, where 0 represents no pain and 10 represents the worst imaginable pain. Participants will be asked to mark the point that best reflects their perceived pain intensity. Higher scores indicate greater pain intensity. | at baseline and after finishing program (up to one month) |
| The Activity Status Index for Duke | Functional capacity will be assessed using the Duke Activity Status Index (DASI), a self-reported 12-item questionnaire that evaluates the ability to perform daily physical activities and estimates functional capacity in metabolic equivalents (METs). Scores range from 0 to 58.2, with higher scores indicating better functional capacity. | at baseline and after finishing program (up to one month) |