The Sternal Management Accelerated Recovery Trial (S.M.A.R.T) – standard restrictive versus an intervention of modified sternal precautions following cardiac surgery via median sternotomy: study protocol for a randomised controlled trial
QUESTION Do trunk stabilisation exercises reduce sternal separation and pain, and improve the quality and control of the performance of tasks in individuals with chronic sternal instability? DESIGN Randomised crossover study with concealed allocation and intention-to-treat analysis. PARTICIPANTS Nine individuals with chronic sternal instability following a median sternotomy for cardiac surgery. INTERVENTION The experimental intervention consisted of six weeks of trunk stabilisation exercises; the control intervention was no exercises. OUTCOME MEASURES Outcomes were sternal separation measured by ultrasound in mm, pain during the performance of nine everyday tasks measured on a 100-mm visual analogue scale, and the quality and control of the performance of two tasks scored on a 100-mm visual analogue scale. RESULTS Overall, sternal separation during the period of trunk stabilisation exercises decreased by 6.2 mm (95% CI 3.5 to 8.9) more than during the control period. Overall, pain decreased when performing everyday tasks by 14 mm (95% CI 5 to 23) more than during the control period. Overall, task performance during the period of trunk stabilisation exercises did not improve (mean difference 10 mm, 95% CI -3 to 22) more than during the control period. CONCLUSION Trunk stabilisation exercises should be included in the rehabilitation of individuals who experience sternal instability following cardiac surgery. A larger trial is warranted to determine if stabilisation exercises are beneficial in improving the quality and control of task performance.