Trunk stabilisation exercises reduce sternal separation in chronic sternal instability after cardiac surgery: a randomised cross-over trial

QUESTION: Do trunk stabilisation exercises reduce sternal separation and pain, and improve the quality and control of the performance of tasks in individuals with chronic sternal instability? DESIGN: Randomised crossover study with concealed allocation and intention-to-treat analysis. PARTICIPANTS: Nine individuals with chronic sternal instability following a median sternotomy for cardiac surgery. INTERVENTION: The experimental intervention consisted of six weeks of trunk stabilisation exercises; the control intervention was no exercises. OUTCOME MEASURES: Outcomes were sternal separation measured by ultrasound in mm, pain during the performance of nine everyday tasks measured on a 100-mm visual analogue scale, and the quality and control of the performance of two tasks scored on a 100-mm visual analogue scale. RESULTS: Overall, sternal separation during the period of trunk stabilisation exercises decreased by 6.2 mm (95% CI 3.5 to 8.9) more than during the control period. Overall, pain decreased when performing everyday tasks by 14 mm (95% CI 5 to 23) more than during the control period. Overall, task performance during the period of trunk stabilisation exercises did not improve (mean difference 10 mm, 95% CI -3 to 22) more than during the control period. CONCLUSION: Trunk stabilisation exercises should be included in the rehabilitation of individuals who experience sternal instability following cardiac surgery. A larger trial is warranted to determine if stabilisation exercises are beneficial in improving the quality and control of task performance