Priporočila za fizioterapijo pri bolnikih po sternotomiji - pregled pregledov literature : diplomsko delo

Kramar, Tajda (author), Tomc Žargi, Tina (mentor), Mlakar, Nataša (comentor), Kacin, Alan (reviewer)

Uvod: Mediana sternotomija je standardni kirurški pristop pri številnih odprtih srčnih operacijah. V pooperativnem obdobju se uporabljajo različne strategije gibanja, pri čemer sodobnejši principi spodbujajo zgodnejše in varnejše vključevanje bolnikov v gibanje. Namen: Namen je bil s pregledom obstoječih pregledov literature raziskati priporočene strategije gibanja in različne omejitve pri bolnikih, ki so bili operirani s sternotomijo in ugotovitve primerjati z veljavnimi smernicami iz Evrope in Amerike za obravnavo bolnikov po sternotomiji. Metode dela: Znanstveno literaturo smo iskali v podatkovni zbirki PubMed in strokovnem omrežju ResearchGate. Uporabili smo iskalno kombinacijo »sternal precautions AND sternotomy«. Rezultati: V pregled literature smo na osnovi vključitvenih in izključitvenih meril vključili en sistematični pregled literature z metaanalizo, en sistematični pregled literature in pet preglednih člankov, objavljenih po letu 2015. V literaturi so bile opisane različne strategije gibanja po mediani sternotomiji, in sicer prsnični previdnostni ukrepi, prilagojeni prsnični previdnostni ukrepi in koncept »gibanja znotraj namišljene cevi«. Avtorji so navajali različna priporočila glede omejitev gibljivosti in dvigovanja bremen, pri čemer se je trajanje omejitev gibljivosti najpogosteje gibalo med 4 in 12 tedni po operaciji, omejitev dvigovanja bremen pa do 12 tednov po operaciji. Najpogosteje navedene omejitve vsakodnevnih dejavnosti so bile izvajanje transferjev, potiskanje in vlečenje, enostranske in dvostranske omejitve uporabe zgornjih udov, uporaba pripomočkov za mobilnost ter delna ali popolna omejitev uporabe zgornjih udov med vsakodnevnimi opravili. Le manjše število raziskav je obravnavalo uporabo zunanjih pripomočkov za stabilizacijo prsnice. Za spremljanje stabilnosti in celjenja prsnice so bile uporabljene lestvica nestabilnosti prsnice, ultrazvočna preiskava, radiografija in računalniška tomografija. Razprava in zaključek: Pregled literature kaže na neenotnost priporočil glede fizioterapevtske obravnave po mediani sternotomiji, predvsem glede trajanja in obsega omejitev. Kljub temu se sodobni principi usmerjajo k manj restriktivni obravnavi, ki spodbuja varno vključevanje bolnikov v vsakodnevne dejavnosti. Še vedno so potrebne dodatne raziskave, ki bi omogočile enotnejše in z dokazi podprte smernice za fizioterapevtsko obravnavo.

• Language: Slovenian
• Keywords: diplomska dela, fizioterapija, mediana sternotomija, fizioterapevtska obravnava, pooperativne omejitve, strategije gibanja, gibanje znotraj namišljene cevi
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [T. Kramar]
• Year: 2026
• Number of pages: VIII, 28 str.
• PID: 20.500.12556/RUL-188177
• UDC: 615.8
• COBISS.SI-ID: 291749635
• Publication date in RUL: 19.09.2026

Secondary language

• Language: English
• Title: Recommendations for physiotherapy in patients after sternotomy - umbrella literature review : diploma work

Abstract

Introduction: Median sternotomy is the standard surgical approach for many open-heart procedures. In the postoperative period, various movement strategies are used, with more contemporary approaches promoting earlier and safer patient mobilization. Purpose: The aim was to investigate recommended movement strategies and various restrictions in patients who had undergone sternotomy by reviewing existing literature reviews and to compare the results with current European and American guidelines for the management of patients following sternotomy. Methods: A literature search was conducted in the PubMed database and the ResearchGate academic network using the search strategy “sternal precautions AND sternotomy”. Results: Based on the inclusion and exclusion criteria, the literature review included one systematic review with meta-analysis, one systematic review, and five review articles published after 2015. The literature described various movement strategies following median sternotomy, including sternal precautions, modified sternal precautions, and the “keep your move in the tube“ concept. Authors reported different recommendations regarding mobility and lifting restrictions, with mobility restrictions most commonly lasting between 4 and 12 weeks postoperatively and lifting restrictions lasting up to 12 weeks after surgery. The most frequently reported limitations in activities of daily living included transfers, pushing and pulling activities, unilateral and bilateral upper limb restrictions, the use of mobility aids and partial or complete limitations in upper limb use during daily activities. Only a small number of studies addressed the use of external devices for sternal stabilization. The sternal instability scale, ultrasound examination, radiography, and computed tomography were used to assess sternal stability and healing. Discussion and conclusion: The literature review indicates a lack of consistency in recommendations regarding physiotherapeutic management after median sternotomy, particularly in terms of the duration and extent of restrictions. Nevertheless, contemporary approaches are shifting toward less restrictive management that promotes the safe inclusion of patients in daily activities. Further research is still needed to develop more consistent, evidence-based guidelines for physiotherapeutic management.

• Keywords: diploma theses, physiotherapy, median sternotomy, physiotherapeutic management, postoperative restrictions, movement strategies, keep your move in the tube