Proprioceptive Neuromuscular Facilitation for improving shoulder range in immediate post cardiac surgery patients-Single blinded Randomized Controlled Trial

In this single blinded randomized controlled trial we aim to find out if addition of Proprioceptive Neuromuscular Facilitation (PNF) movement patterns to conventional therapy improves shoulder range of motion shoulder function and reduces pain  when compared to conventional therapy alone in immediate post cardiac surgery patients through median sternotomy.

Persons admitted in cardiothoracic unit for cardiac surgery through median sternotomy will be screened for eligibility by the principal investigator and will be included pre-operatively after a written consent. Baseline assessment will be performed pre-operatively by a physical therapist (PT1) who will be blinded to the group allocation  which will include assessment of shoulder range of motion - external rotation  abduction and flexion using inertial measuring unit (IMU) pain evaluation using Numerical pain rating scale (NPRS) and shoulder functional activity will be evaluated using University of California  Los Angeles (UCLA) Shoulder Rating Score. The UCLA Shoulder Rating Scale which is already part of our outcome measures  includes a specific question assessing patient satisfaction with shoulder function and pain. Hence  this scale will capture both functional improvement and the patient’s subjective satisfaction with recovery. Following cardiac surgery through median sternotomy participants will be randomly allocated to either control or interventional group using sequentially numbered opaque sealed envelopes (SNOSE). Control group will receive 1 week of conventional therapy  which consists of active shoulder range of motion exercises while the interventional group will receive 1 week of PNF shoulder exercise in addition to conventional therapy. The PNF pattern exercises which will be used in this study are D1 Flexion – Extension (diagonal pattern 1) and D2 Flexion – Extension (diagonal pattern 2) of Upper Limb. At the end of 1 week the same outcomes will be re-assessed to find out and compare the effect of PNF pattern exercise  when used in addition to conventional therapy versus conventional therapy alone on range of motion, pain and shoulder function. . Each participant will receive 1 week of supervised therapy in the hospital followed by a home exercise program sheet to continue the prescribed exercises independently. After 3 months participants will return for follow-up assessment  and all outcome measures will be reassessed to evaluate long-term effects. At 3 month follow-up  outcomes will be re- assessed to determine the incidence of adhesive capsulitis in post-operative cardiac patients. Only trained and qualified physiotherapists of the institution will deliver all interventions .