PHTY4007 - The Randomised Controlled Trial (RCT) - Medical Science Assignment Help

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The randomised controlled trial (RCT) evaluates the intervention of inpatient outcomes of physiotherapy exercise protocol post coronary artery bypass graft (CABG) surgery, known as the exercise group, compared to usual physiotherapy respiratory intervention. The participants of the study were patients undergoing elective CABG with cardiopulmonary bypass. The inclusion criteria for these patients were a diagnosis of coronary artery disease (CAD) and clinical indications for CABG. The exclusion criteria emergent or concomitant surgery, previous cardiac surgery, recent myocardial infarction (6 months), implanted pacemaker, unstable angina, chronic disturbances in heart rhythm, significant acute arrhythmias (atrial flutter, atrial fibrillation, multiple ventricular or atrial ectopy, second- or third- degree atrioventricular block), valvular heart disease, chronic obstructive pulmonary disease, diabetic neuropathy, severe non-cardiac diseases or the inability to perform exercise according to our protocol.

The exercise group involved once-daily physiotherapy supervised post-operative exercise protocol of early mobilisation (Table 1), commencing on the first day post-operative until discharge. The exercise group was compared to the usual care group, which involved voluntary deep-breathing exercises from functional residual capacity to total lung capacity. The intervention involved four sets of 10 deep breaths with five-second hold at the end of each inspiration and a cough or huff at the end of each set with wound support. However, both groups participated in usual physiotherapy care, the objective was to evaluate whether exercise had greater impact to the primary outcome measure.

The RCT’s primary outcome measure was heart rate. Severe impairment of cardiac autonomous regulation (CAR) assessed by heart rate variability (HRV) has been observed post CABG. Lower heart rate variability indicates an intrinsic impairment to the regulation of the heart’s sinoatrial node rhythm, leading the subject to be less able to tolerate perturbation in physiological homeostasis. The relevance of an imbalance of HRV has been shown to increase the propensity for haemodynamic instability, arrhythmias, and sudden death. Secondary outcome measures included: respiratory rate, blood pressures, and body temperature.

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