Effectiveness of Myofascial Release in Patients With Chronic Post Sternotomy Pain Syndrome
- Conditions
- Chronic Postsurgical Pain
- Interventions
- Other: Myofascial releaseOther: Breathing exercisesDrug: Pharmacological treatment
- Registration Number
- NCT06630208
- Lead Sponsor
- Cairo University
- Brief Summary
The main aim of this study is to investigate the effectiveness of Myofascial release in patients with chronic sternotomy pain.
- Detailed Description
Post-sternotomy pain syndrome (PSPS) is a prevalent disorder affecting a substantial proportion of patients who have undergone sternotomy surgery, with incidence rates ranging from 10% to 40%. Several mechanisms have been proposed to be responsible for the development of PSPS; for example, intercostal neuralgia from scar-entrapped neuroma, brachial plexus injury, ribs or costal fractures with incomplete healing, sternal wound infections and even hypersensitivity reaction to sternal wire. chronic post sternotomy pain (CPSP) can compromise quality of life, affecting their sleep patterns and impairing their working ability.
During the first week after coronary artery bypass grafting (CABG) surgery, vital capacity (VC) decreases by 30-60% and even up to 1 year this remains reduced by 12%. Reduced VC has a negative effect on exercise tolerance (Vo2max) and therefore it is important to optimize pulmonary function after CABG surgery. The decreased thoracic mobility after CABG still presents 12 months after surgery. Thoracic mobility and vital capacity were affected more when the left internal thoracic artery (LITA)-retractor was used and reduced thoracic mobility is related to diminished pulmonary function.
New therapeutic-rehabilitative proposals have been tried in cardiac patients. After cardiac surgery, it was found that the responses of the cardiovascular, and respiratory systems get better after neuromuscular manual therapy. The strong correlation between manual therapy and its effects, suggests that a central control mechanism could be activated by manual therapy.
Using Myofascial release (MFR) techniques may be beneficial for patients post-CABG and off-pump coronary artery bypass grafting (OPCAB) surgery. The advantages of MFR techniques are gentleness and non-invasiveness. During therapy one works with fascia structures, thus, not influencing bone structures directly, These techniques are comfortable and safe, they may be applied in acute conditions.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 60
- Chronic Post-sternotomy pain (CPSP), defined as discomfort at the thorax after cardiac surgery, persisting for at least 2 months, and without apparent cause (I.e., such as infection or the underlying disease that motivated the surgery).
- Age between 55 to 65 years old.
- All patients will be under full medical supervision.
- Adherence to informed consent.
- Cardiac sternotomy intervention
- Neuromuscular disorders.
- Any Active hemorrhage.
- The presence of an unstable cardiac, pulmonary or cerebral pathology.
- Poor cognition and mentality.
- Patients with active contagious skin conditions
- Any Cardiopulmonary problems (eg. Uncontrolled hypertension, Heart Failure, Arrhythmia)
- Patients with malignancy.
- Any acute viral infection.
- Patients with ascites or end-stage liver or kidney failure.
- Patients will participate in other physiotherapy programs rather than the prescribed protocol.
- Chest infection in last 3 months.
- Patients with musculoskeletal problems like any bone fracture
- Osteoporotic patients.
- Any recent open wound in the chest are.
- Hemodynamic instability.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Myofascial release + Breathing exercises + Pharmacological treatment Pharmacological treatment It will include 30 patients, who will receive myofascial release for 5 days, with breathing exercises in addition to pharmacological treatment. Pharmacological treatment Pharmacological treatment It will include 30 patients, who will receive pharmacological treatment only. Myofascial release + Breathing exercises + Pharmacological treatment Myofascial release It will include 30 patients, who will receive myofascial release for 5 days, with breathing exercises in addition to pharmacological treatment. Myofascial release + Breathing exercises + Pharmacological treatment Breathing exercises It will include 30 patients, who will receive myofascial release for 5 days, with breathing exercises in addition to pharmacological treatment.
- Primary Outcome Measures
Name Time Method Visual analog scale (VAS) 5 days Scores are based on self-reported measures of symptoms that are recorded with a single handwritten mark placed at one point along the length of a 10-cm line that represents a continuum between the two ends of the scale-"no pain" on the left end (0 cm) of the scale and the "worst pain" on the right end of the scale (10 cm).
Upper chest expansion 5 days It will be obtained by subtracting the inspiratory diameter from the expiratory diameter, according to the designated anatomical markers.
Lower chest expansion 5 days It will be obtained by subtracting the inspiratory diameter from the expiratory diameter, according to the designated anatomical markers.
Pressure pain threshold 5 days Pressure algometers are useful for quantifying the pressure pain thresholds of muscles. The pressure pain threshold of a patient is judged to be abnormal when the pressure pain threshold was lower than the normal value or if the pressure pain threshold of a certain site was lower than that of the opposite site by at least 2 kg/cm2, or if it was less than 3 kg/cm2.
- Secondary Outcome Measures
Name Time Method Forced vital capacity (FVC) 5 days It will be assessed by a spirometer before and after treatment. The patient will be asked to take a deep inspiration to expire forcefully and rapidly as much as possible through the mouthpiece.
Forced expiratory volume at one second (FEV1) 5 days It will be assessed by a spirometer before and after treatment. The patient will be asked to take a deep inspiration to expire forcefully and rapidly as much as possible through the mouthpiece.
FEV1/FVC 5 days The ratio between the forced expiratory volume at one second (FEV1) and forced vital capacity (FVC) will be calculated before and after treatment.
Katz Index of Independence in Activities of Daily Living (ADL) 5 days The Katz ADL index measures the self-care tasks which include bathing, dressing, toileting, transferring to and from a chair, maintaining continence and feeding. Answers are given in a dichotomous manner - yes or no for each task. The scores indicate the levels of functional impairments; total score of 6 - full function, 3 to 5 - moderate functional impairment, and 2 or less - severe functional impairment.
6-min walk test (6 MWT) 5 days The total distance walked in meters will be measured.
Pittsburgh Sleep Quality Index (PSQI) 5 days The PSQI was designed to evaluate overall sleep quality in these clinical populations. Each of the questionnaire's 19 self-reported items belongs to one of seven subcategories: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction.
Arabic version of the 12-item short-form health survey (SF-12) 5 days It will be used to assess the quality of life. The Arabic version of the SF-12 is a reliable, easy-to-use, and valid tool to measure health-related quality of life in the general population.
The Readiness for Return to Work (RRTW) 5 days The Readiness for Return to Work (RRTW) model attempts to describe the intricate process of returning to work after a long-term sickness absence. The scale comprises 22 questions, which are divided into 13 questions for those who are not back to work yet, and 9 questions for those who are currently back at work.
Trial Locations
- Locations (1)
Cairo University
🇪🇬Giza, Egypt