ACPRC scoping review of post-operative physiotherapy in people undergoing cardiac surgery

Introduction This scoping review was produced by the ACPRC editorial board. Surgery was considered one of five key priorities for review and was subsequently separated into surgical specialities. Objective The objective of this scoping review was to report the extent and methodological type of evidence associated with post-operative physiotherapy in people who underwent cardiac surgery. Inclusion criteria Studies with adult patients undergoing cardiac surgery, requiring post-operative physiotherapy intervention, as part of the recovery process, and published between 2014 and 2021 were included. Method Searches were undertaken in PEDro, CINAHL, EMBASE, MEDLINE, PubMed, Google Scholar and the Clinical Trials Registry. Article titles and abstracts were screened by one reviewer, and full text articles appraised by two reviewers. Quality was assessed and data was extracted using the relevant tools. Results Initially, 2795 articles were retrieved, 41 articles were included in this scoping review. The most frequent study methodologies were randomised control trials (n = 21), observational studies (n = 8), systematic reviews (n = 3) and qualitative studies (n = 2). The sample sizes tended to be small and single centred. Included studies explored mobilisation (n = 18), respiratory physiotherapy (n = 12), sternal wound precautions (n = 7), staff or patient experience (n = 3) and adverse events (n = 1). Targeted respiratory physiotherapy may be beneficial for patients who are at high-risk of developing or have developed post-operative complications. Early mobilisation shows good evidence to reduce length of stay. Allowing patients more liberal use of their upper-limbs has also been shown to expedite recovery and reduce care needs on discharge without increasing sternal wound breakdown, infection or pain. Conclusion The literature showed positive outcomes for physiotherapy interventions involving early mobility and allowing an increase in upper-limb usage. Respiratory physiotherapy techniques are beneficial when used with appropriate patients. Cost effectiveness analysis should be undertaken. There is scope for an increase in qualitative studies to be undertaken to focus on patient experience and patient reported outcomes.