Effectiveness of Preoperative Physical Therapy for Elective Cardiac Surgery

<LEAP> highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions—medications, surgery, education, nutrition, exercise—and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature.¹ Each article in this PTJ series summarizes a Cochrane review or other scientific evidence resource on a single topic and will present clinical scenarios based on real patients to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on the effectiveness of preoperative physical therapy for elective cardiac surgery. More specifically, does preoperative physical therapy prevent postoperative pulmonary complications in patients undergoing elective cardiac surgery, and, if so, what types of interventions are most effective, and do patients with certain characteristics benefit from therapy?

The American Heart Association has reported that the total number of inpatient cardiovascular operations and procedures increased 28% between 2000 and 2010, to 7,588,000 in 2010.² Despite a decrease in coronary artery bypass graft (CABG) surgery, this surgery remains common; almost 400,000 CABG procedures were performed in the United States in 2010.³ Although there has been a reduction in overall postoperative mortality, there is ample evidence that the risk of pulmonary complications increases morbidity and mortality.^2,4

Depression of the respiratory center due to preoperative and postoperative anesthesia and analgesia may result in altered breathing patterns, which can be complicated by restrictive lung …