title: Management of sternal precautions following median sternotomy by physical therapists in Australia: a web-based survey.
abstract: BACKGROUND
  Sternal precautions are utilized within many hospitals with the aim of preventing the occurrence of sternal complications (eg, infection, wound breakdown) following midline sternotomy. The evidence base for sternal precaution protocols, however, has been questioned due to a paucity of research, unknown effect on patient outcomes, and possible discrepancies in pattern of use among institutions.
  
  
  OBJECTIVE
  The objective of this study was to investigate and document the use of sternal precautions by physical therapists in the treatment of patients following median sternotomy in hospitals throughout Australia, from immediately postsurgery to discharge from the hospital.
  
  
  METHODS
  A cross-sectional, observational design was used. An anonymous, Web-based survey was custom designed for use in the study.
  
  
  METHODS
  The questionnaire was content validated, and the online functionality was assessed. The senior cardiothoracic physical therapist from each hospital identified as currently performing cardiothoracic surgery (N=51) was invited to participate.
  
  
  RESULTS
  The response rate was 58.8% (n=30). Both public (n=18) and private (n=12) hospitals in all states of Australia were represented. Management protocols reported by participants included wound support (n=22), restrictions on lifting and transfers (n=23), and restrictions on mobility aid use (n=15). Factors influencing clinical practice most commonly included "workplace practices/protocols" (n=27) and "clinical experience" (n=22). Limitations The study may be limited by response bias.
  
  
  CONCLUSIONS
  Significant variation exists in the sternal precautions and protocols used in the treatment of patients following median sternotomy in Australian hospitals. Further research is needed to investigate whether the restrictions and precautions used are necessary and whether protocols have an impact on patient outcomes, including rates of recovery and length of stay.
authors.affiliation: BPhysio, Maitland Private Hospital, Maitland, New South Wales, Australia.
authors.forename: Lara J
authors.initials: LJ
authors.lastname: Tuyl
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Mackney
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Johnston
mesh_terms: D001315:Australia; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D006801:Humans; D020407:Internet; D051346:Mobility Limitation; D026741:Physical Therapy Modalities; D056346:Sternotomy; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D011795:Surveys and Questionnaires