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

Официальное название

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

Обзор

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.

Подробное описание

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.

Вмешательства

• Другое 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.
• Другое 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.

Первичные конечные точки

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

Вторичные конечные точки (6)

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

Критерии участия

Критерии включения

• 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.

Критерии исключения

• 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.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

Turkey (Türkiye) · 1 центр

• Bezmialem Vakif University — Istanbul

Идентификаторы

NCT: NCT07725887 · 2026/315

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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