Structured Inpatient Physiotherapy in High-Risk Coronary Artery Bypass Grafting Patients

Official title

Effect of a Preoperatively Initiated Structured Inpatient Physiotherapy Program on Postoperative Outcomes in High-Risk Coronary Artery Bypass Grafting Patients

Overview

Coronary artery bypass grafting (CABG) may be associated with prolonged recovery, particularly in high-risk patients. Although preoperative rehabilitation has shown promising results, evidence remains limited because of heterogeneous intervention protocols and variations in postoperative care. This study aims to investigate the effects of a structured inpatient physiotherapy program initiated at least two days before surgery and continued postoperatively, compared with the same structured physiotherapy program provided only during the postoperative period, in high-risk CABG patients. The primary outcome is hospital length of stay. Secondary outcomes include intensive care unit length of stay, C-reactive protein, neutrophil-to-lymphocyte ratio, hemoglobin, dyspnea, and fatigue.

Detailed description

Coronary artery bypass grafting (CABG) is commonly performed for the treatment of coronary artery disease. Postoperative recovery may be prolonged in patients with advanced age, reduced left ventricular ejection fraction, multivessel coronary artery disease, smoking history, and multiple comorbidities.

Preoperative rehabilitation has been proposed as a strategy to support postoperative recovery. However, previous studies have used heterogeneous intervention protocols and different postoperative care approaches.

This study will compare two physiotherapy strategies in high-risk CABG patients. Participants in the intervention group will receive a structured inpatient physiotherapy program initiated at least two days before surgery and continued postoperatively. The program includes breathing exercises, incentive spirometry, bronchial hygiene techniques, progressive early mobilization, and postural exercises. Before surgery, one supervised session will be provided daily, and participants will be instructed to repeat the program independently twice daily.

Participants in the control group will receive the same structured physiotherapy program only during the postoperative period.

The primary outcome is hospital length of stay. Secondary outcomes include intensive care unit length of stay, hemoglobin, C-reactive protein, neutrophil-to-lymphocyte ratio, dyspnea, and fatigue.

Interventions

• Other Preoperative and Postoperative Structured Inpatient Physiotherapy
  Participants will receive a structured inpatient physiotherapy program initiated at least two days before CABG surgery and continued throughout postoperative hospitalization. The program includes breathing exercises, incentive spirometry, bronchial hygiene techniques, progressive early mobilization, and postural exercises. Before surgery, one supervised session will be provided daily, and participants will be instructed to repeat the program independently twice daily.
• Other Postoperative Structured Inpatient Physiotherapy
  Participants will receive the same structured inpatient physiotherapy program only during the postoperative hospitalization. The program includes breathing exercises, incentive spirometry, bronchial hygiene techniques, progressive early mobilization, and postural exercises.

Primary outcome measures

• Hospital Length of Stay [Time frame: From surgery until hospital discharge (approximately 7-14 days)]

Secondary outcome measures (6)

• Intensive Care Unit Length of Stay [Time frame: From surgery until discharge from the intensive care unit (approximately 1-5 days)]
• Hemoglobin [Time frame: Baseline (preoperative), through hospital discharge (up to approximately 30 days after surgery), and 7-10 days after hospital discharge.]
• C-Reactive Protein (CRP) [Time frame: Baseline (preoperative), through hospital discharge (up to approximately 30 days after surgery), and 7-10 days after hospital discharge.]
• Neutrophil-to-Lymphocyte Ratio (NLR) [Time frame: Baseline (preoperative), through hospital discharge (up to approximately 30 days after surgery), and 7-10 days after hospital discharge.]
• Dyspnea [Time frame: At the first postoperative physiotherapy session on the surgical ward and at the final physiotherapy session before hospital discharge.]
• Fatigue [Time frame: At the first postoperative physiotherapy session on the surgical ward and at the final physiotherapy session before hospital discharge.]

Eligibility criteria

Inclusion criteria

• Adults aged 18 years or older.
• Scheduled to undergo elective coronary artery bypass grafting (CABG).
• High-risk patients meeting at least three of the following criteria:

Left ventricular ejection fraction (LVEF) <40%. Three-vessel coronary artery disease. More than two comorbidities. History of smoking. Age >65 years.

\- Able and willing to provide written informed consent.

Exclusion criteria

• Planned redo CABG surgery.
• Severe neurological or orthopedic conditions limiting mobilization.
• Severe cognitive impairment.
• Hemodynamic instability.
• Contraindications to mobilization or exercise.
• Inability to complete at least two days of the preoperative physiotherapy program.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• Bezmialem Vakif University — Istanbul

Identifiers

NCT: NCT07725887 · 2026/315

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗