title: Upper limb exercise prescription following cardiac surgery via median sternotomy: a web survey.
abstract: OBJECTIVE
  Following cardiac surgery via median sternotomy, patients are routinely advised to adhere to upper limb restrictions to prevent the development of sternal complications. However, there is no definitive evidence to support the clinical application of such restrictions. The purpose of this study was to investigate current physiotherapy practice regarding upper limb exercise guidelines for this population, within outpatient cardiac rehabilitation in Australia.
  
  
  METHODS
  Physiotherapists working within outpatient cardiac rehabilitation programs in Australia were invited to complete a Web survey.
  
  
  RESULTS
  The response rate was 77%. The majority of respondents (96%) prescribed upper limb exercises to patients following median sternotomy, with 95% placing restrictions on these exercises. At 6 weeks postoperatively, 58% and 73% of respondents still placed restrictions on unloaded and loaded unilateral upper limb elevation exercises respectively; similarly, 55% and 74% placed restrictions on unloaded and loaded bilateral upper limb elevation exercises, respectively. However, there was a lack of consensus on the type and timing of these restrictions, with patient-reported pain being the main parameter used to guide upper limb exercise prescription and progression. Only 43% reported screening for sternal instability, and if detected, the majority based their management on clinical experience.
  
  
  CONCLUSIONS
  There is significant variation in practice with respect to the prescription and progression of upper limb exercises, within outpatient cardiac rehabilitation in Australia. Further research is warranted to establish evidence-based guidelines for the upper limb rehabilitation of patients following cardiac surgery via median sternotomy.
authors.affiliation: Physiotherapy Department, The University of Melbourne, Carlton, Victoria, Australia (Ms Balachandran and Drs Lee, Denehy, and El-Ansary); and Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia (Dr Royse).
authors.forename: Sulakshana
authors.initials: S
authors.lastname: Balachandran
authors.forename: Annemarie
authors.initials: A
authors.lastname: Lee
authors.forename: Alistair
authors.initials: A
authors.lastname: Royse
authors.forename: Linda
authors.initials: L
authors.lastname: Denehy
authors.forename: Doa
authors.initials: D
authors.lastname: El-Ansary
mesh_terms: D001315:Australia; D006348:Cardiac Surgical Procedures; D003430:Cross-Sectional Studies; D005081:Exercise Therapy / Q000379:methods / Q000706:statistics & numerical data; D019538:Health Care Surveys / Q000379:methods* / Q000706:statistics & numerical data; D006331:Heart Diseases / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D020407:Internet; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D056346:Sternotomy; D011795:Surveys and Questionnaires; D034941:Upper Extremity