Physiotherapy Theory and Practice, 28(3):178–187, 2012

Copyright © Informa Healthcare USA, Inc.

ISSN: 0959-3985 print/1532-5040 online
DOI: 10.3109/09593985.2011.582231

DESCRIPTIVE REPORT

Physiotherapy for patients following coronary artery

bypass graft (CABG) surgery: Limited uptake of
evidence into practice
Stephanie R. Filbay, BPhysio(Hons),1 Kate Hayes, BPhysio(Hons), MPhysio(Cardio),2 and
Anne E. Holland, BAppSc(Physio), PhD3
Physiother Theory Pract Downloaded from informahealthcare.com by McMaster University on 11/04/14

1
School of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia
2
Senior Clinician Physiotherapist, Cardiothoracic Services, Alfred Health Department of Physiotherapy, Alfred Hospital,
Prahran, Victoria, Australia
3
La Trobe University and Alfred Health, Melbourne, Victoria, Australia

ABSTRACT
The efficacy of physiotherapy techniques used for patients following uncomplicated coronary artery bypass sur-
gery (CABG) is well documented. Previous research showed that some of this evidence was not rapidly adopted
For personal use only.

into practice by cardiothoracic physiotherapists; however, there has been no recent evaluation of the uptake of
evidence. Our aim was to identify current physiotherapy interventions in use for patients following uncomplicated
CABG surgery. A survey was sent to senior cardiothoracic physiotherapists from all Australian and New Zealand
hospitals that perform CABG surgery. Fifty-four surveys were returned (response rate 88%). The most common
treatments used were mobilisation (94% of hospitals), range of motion exercises (79%), deep breathing and/or
cough (77%), cardiovascular exercise (42%), and incentive spirometry (40%). Respondents with a bachelor or
diploma in physiotherapy were more likely to implement deep breathing exercises or coughing than those who
obtained a postgraduate degree ( p = 0.045). Respondents perceived personal experience as the most influential
factor on postoperative treatment choices. Physiotherapists treating patients following uncomplicated CABG
surgery continue to use interventions such as deep breathing exercises that are not supported by best available
evidence. Standardised guidelines may be required to better match clinical practice with current literature.

INTRODUCTION Research suggests that some currently used phy-

Physiotherapy treatment following coronary artery
bypass graft (CABG) surgery aims to minimise post-
operative pulmonary complications (PPCs) such as at-
electasis, arterial hypoxemia, and respiratory infection,
which are the primary causes of morbidity and mor-
tality following CABG surgery (Crowe and Bradley,
1997; Matte, Jacquet, Van Dyck, and Goenen, 2000;
Oikkonen et al, 1991; Westerdahl et al, 2005). Phy-
siotherapy techniques are also used to manage second-
ary complications such as pain and stiffness, restore
mobility and function, and improve postoperative
quality of life (Herdy et al, 2008; Peric et al, 2008).
Accepted for publication 4 April 2011
Address correspondence to Anne E. Holland, BAppSc (Physio), PhD, La
Trobe University and Alfred Health, 99 Commercial Rd., Melbourne,
Victoria 3004. E-mail: a.holland@latrobe.edu.au
siotherapy interventions may be of no benefit to
patients following uncomplicated CABG surgery.
Physiotherapy during the intubation period following
CABG surgery does not appear to alter the rate of pul-
monary complications (Patman, Sanderson, and
Blackmore, 2001). Deep breathing exercises (DBEs)
are of no additional benefit to a patient following
CABG surgery compared to early mobilisation alone
(Brasher, McClelland, Denehy, and Story, 2003;
Jenkins et al, 1989; Jenkins et al, 1990; Johnson
et al, 1995; Pasquina, Tramèr, and Walder 2003;
Stiller et al, 1994). Likewise, percussion, incentive
spirometry (IS), intermittent positive pressure breath-
ing (IPPB), and continuous positive airway pressure
(CPAP) do not appear to have additional benefits
following uncomplicated CABG surgery (Matte,
Jacquet, Van Dyck, and Goenen, 2000; Oikkonen
et al, 1991). In contrast, positive expiratory pressure

178

(PEP) therapy using a blow bottle device reduces at-
electasis and improves respiratory function compared
to controls performing deep breathing with no
device or no DBEs (Westerdahl, Lindmark,
Almgren, and Tenling, 2001; Westerdahl et al,
2005); however, the clinical implications of these find-
ings are uncertain. Although some studies have found
benefits of upper limb and thoracic range of move-
ment (ROM) exercises, results are inconsistent
across trials (Aida et al, 2002; Shaw, Deutsch, and
Bowling 1989; Stiller, McInnes, Huff, and Hall,
1997). The strongest evidence for physiotherapy
management is in the area of early and progressive
Physiother Theory Pract Downloaded from informahealthcare.com by McMaster University on 11/04/14
mobilisation and walking training. Postoperative
CABG patients who mobilise more frequently and
for a greater duration than their counterparts achieve
functional milestones more quickly, have greater
walking capacity at discharge from hospital, and
higher levels of satisfaction with their treatment
(Hirschhorn et al, 2008; Van der Peijl et al, 2004).
Previous research has shown that postoperative phy-
siotherapy management of patients following CABG
surgery was not consistent with available scientific evi-
dence. Tucker et al (1996) found that patient position-
For personal use only.
ing, early mobilisation, and DBEs were the treatments
most frequently utilised on routine patients, with 94%
of respondents reporting the use of deep breathing exer-
cises. This was despite available evidence that suggested
that deep breathing exercises do not improve clinical
outcomes in routine, uncomplicated patients. Tucker
et al (1996) concluded that physiotherapists were “re-
luctant to change current practice based on research
findings.” Since 1996, the evidence base regarding the
benefits of CABG management strategies has grown
considerably (Brasher, McClelland, Denehy, and
Story, 2003; Hirschhorn et al, 2008; Matte, Jacquet,
Van Dyck, and Goenen, 2000; Patman, Sanderson,
and Blackmore, 2001; Van der Peijl et al, 2004;
Westerdahl, Lindmark, Almgren and Tenling, 2001;
Westerdahl et al, 2005). These new findings support
the need for a current overview of practices. The aim
of this study was to determine current postoperative
CABG physiotherapy practice in Australian and New
Zealand hospitals and evaluate whether these practices
are supported by current evidence.
METHODS
Design
A prospective survey was undertaken. Ethical per-
mission was granted by the human research ethics
committee of Latrobe University, Victoria, Australia.
Physiotherapy Theory and Practice
Physiotherapy Theory and Practice 179
A new questionnaire was constructed for this study
(Appendix 1). The survey was based on a systematic
review of the literature conducted by the authors in
2009, with questions that were designed to document
the use of physiotherapy techniques that were reported
in the literature, as well as perceived influences on
choice of treatment techniques and demographic
characteristics of respondents. The questions were
structured to allow direct comparison to Tucker et al
(1996) where possible. An initial draft was checked
for face validity by two physiotherapists and a final
draft piloted by a small group of physiotherapists
who did not participate in the study (Del Greco and
Walop, 1987). The questionnaire was revised for
clarity on the basis of the feedback obtained. The
questionnaire is available in the Appendix and as an
online supplement.
Participants
Senior cardiothoracic physiotherapists from every
hospital in Australia and New Zealand who per-
formed CABG surgery were invited to participate.
Physiotherapists were informed that return of the
questionnaire implied their consent to participate in
the study.
Recruitment
A comprehensive list of hospitals in Australia and New
Zealand that perform CABG surgery was obtained by
synthesis of data from three separate sources: 1)
Australian Institute of Health and Welfare website
(2009), 2) a consulting cardiothoracic surgeon, and
3) the Australasian Society for Cardiac and Thoracic
Surgeons. These lists were cross-checked and any dis-
crepancies resolved via telephone calls to the hospitals.
Procedure
A questionnaire and introductory letter were distribu-
ted via post to each hospital in February 2010. Each
letter contained a reply paid, preaddressed envelope.
The introductory letter explained the research ration-
ale and relevance of the study. Follow-up phone calls
were made to all hospitals that had not returned the
questionnaire within the designated 2-week period.
Questionnaires were reissued to any participants who
had not received or had misplaced the original. An
additional month was designated to allow return of
these surveys before commencing data analysis. Each
questionnaire contained a numeric code to ensure
 180 Filbay et al.
hospital confidentiality. This code was only used when
a follow-up phone call was necessary. Once all ques-
tionnaires were received, responses from all hospitals
were de-identified for data entry.
Statistical analyses
Descriptive statistics were primarily used for analyses.
Normality of the data was assessed by using Kolgarov-
Smirnov test. Data that were not normally distributed
were reported as median and range, with all other
values given as means and standard deviations (SDs).
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Differences between categorical variables, including
differences in reported treatments between experienced
physiotherapists (more than 6 years since graduation)
and inexperienced physiotherapists, were determined
by using Pearson’s chi-square test. A critical alpha
probability (p) value of less than 0.05 was taken to rep-
resent statistical significance.
RESULTS
For personal use only.
Sixty-four surveys were sent, of which 56 were
returned, giving a response rate of 88%. Of those
returned, three were excluded because CABG surgery
was not performed at the hospital. A total of 53
surveys were included in analysis. The majority of
returned surveys were from New South Wales (n =
14, 26%), Victoria (n = 13, 25%), New Zealand (n =
10, 19%), and Queensland (n = 9, 17%). Twenty-five
surveys (47%) were received from public hospitals, 27
surveys (51%) were from private hospitals, and one
respondent (2%) treated both private and public
patients. A median of eight patients (range 2–28)
underwent CABG surgery at respondents’ institutions
each week, with an estimated median length of stay of
6 days (range 4–8 days).
Experience and qualifications
The majority of respondents were experienced phy-
siotherapists, with 38 (72%) having worked for more
than 6 years since graduation and 28 (53%) having
worked for more than 12 years since graduation. In
the field of cardiothoracic physiotherapy, 19 respon-
dents (36%) had greater than 12 years experience,
and 25 (47%) had worked 6 years or less in cardi-
othoracics. A Bachelor of Physiotherapy, Diploma,
or Master in Physiotherapy (Graduate Entry) degree
was obtained by 43 of the 53 respondents (81%). A
total of ten respondents (19%) had completed post-
graduate studies.
Postoperative physiotherapy management
The majority of respondents (n = 36, 68%) reported
that physiotherapists in their hospital assessed and
treated all patients following CABG surgery, whereas
15 respondents (28%) assessed all patients but only
implemented treatment when deemed necessary.
One respondent (2%) reported physiotherapists in
their hospital did not assess or treat patients routinely
(seen by referral only). Patients following uncompli-
cated surgery were reviewed once daily at 30 hospitals
(57%), whereas eight respondents (15%) reported
seeing these patients twice daily and 11 respondents
(21%) reported seeing uncomplicated patients two
times per day on day 1 and 2, and once per day from
day 3 onward. The majority of respondents (n = 51,
96%) indicated that postoperative patients were first
seen by a physiotherapist on the first postoperative day.
All respondents indicated that patients were nursed
in an intensive care unit (ICU) immediately following
surgery. Physiotherapists in three hospitals (6%) routi-
nely treated uncomplicated patients while intubated in
ICU. These treatments consisted of positioning and
suctioning, with physiotherapists in only one hospital
(2%) performing manual hyperinflation and ventilator
hyperinflation prior to extubation.
Physiotherapy interventions
A range of physiotherapy treatments were utilised
routinely on uncomplicated postoperative CABG
patients (Figure 1). Deep breathing exercises or
coughing was performed by 41 respondents (77%),
and mobilisation was utilised at 50 hospitals (94%). In-
centive spirometry was implemented by 21 respondents
(40%). Respondents with a postgraduate degree were
significantly less likely to utilise breathing techniques
or coughing as a treatment strategy than respondents
with a bachelor or diploma in physiotherapy ( p =
0.045). Deep breathing or coughing was implemented
in 23 private hospitals (86%) and 17 (68%) public hos-
pitals ( p = 0.12). Clinical pathway use ( p = 0.204) and
having greater than 6 years of physiotherapy experience
( p = 0.301) did not significantly affect the likelihood of
undertaking DBEs.
All respondents reported that patients were sat out
of bed following surgery on day 1. This was performed
by physiotherapists at 20 hospitals (38%), nurses at 13
hospitals (25%), and by both the nurse and phy-
siotherapist at 20 hospitals (38%). All hospitals in-
cluded walking in postoperative management, with
day 1 the median time of commencement (range
1–2). Patients ambulated most often with a
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For personal use only.
FIGURE 1 Physiotherapy interventions routinely performed for patients following uncomplicated CABG surgery.
physiotherapist (n = 40, 76%), with some respondents
reporting mobilisation was undertaken by a nurse (n =
5, 9%), or either a physiotherapist or a nurse (n = 8,
15%). The majority of respondents (96%) assessed
the ability of patients to safely perform stairs at a
median of day 4 (range 2–6), and this was always
done by a physiotherapist. Two respondents (4%)
did not give their patients home exercise programs;
those that did were taught by physiotherapists in
87% of hospitals commencing at a median of day 5
(range 3–7). Upper limb and trunk range of motion
(ROM) exercises were implemented at a median of
day 2 (range 0–5) by physiotherapists at all but six hos-
pitals (11%) where respondents did not routinely
perform ROM exercises.
Influences on clinical practice
Forty-eight respondents (91%) indicated that their
postoperative management of uncomplicated
CABGs patients was guided by a clinical care
pathway. Physiotherapist experience was perceived as
the most influential factor in determining postopera-
tive practice, and peer pressure was deemed least
influential (Figure 2). Respondents were asked to
Physiotherapy Theory and Practice
Physiotherapy Theory and Practice 181
identify specific literature that was influential to their
postoperative treatment choices, and 33 (63%) were
able to identify at least one peer-reviewed journal
article. Articles on DBEs featured most frequently,
with 19 respondents (36%) citing one or more of the
articles that have reported no advantage of DBEs over
no treatment or usual physiotherapy care. The most
frequently cited articles were Brasher, McClelland,
Denehy, and Story (2003), which was mentioned by
30% of respondents; Stiller et al (1994), mentioned
by 23% of respondents; and Jenkins et al (1990) by
22% of respondents. Despite the perception that
these articles were influential on practice, 12 (63%)
of those who cited articles reporting no benefits of
DBEs also reported that they used this technique as
a routine postoperative intervention.
DISCUSSION
The results of this study show that some aspects of
physiotherapy management of uncomplicated CABG
patients in Australian and New Zealand hospitals may
not be based on currently available evidence. Deep
breathing and coughing (77%) and incentive spirome-
try (40%) continue to be widely used, despite literature
 182 Filbay et al.
Physiother Theory Pract Downloaded from informahealthcare.com by McMaster University on 11/04/14
FIGURE 2 Factors perceived as being moderately or very influential on treatment choices for patients following uncomplicated
For personal use only.
CABG surgery.
consistently indicating no benefit in routine CABG
patients (Brasher, McClelland, Denehy, and Story,
2003; Crowe and Bradley, 1997; Dull and Dull,
1983; Jenkins et al, 1990; Johnson et al, 1995; Savci
et al, 2006; Stiller et al, 1994). Mobilisation was the
most frequently implemented intervention (94% of
respondents) and has sound evidence indicating
benefits to this patient population (Hirschorn et al,
2008).
Tucker et al (1996) reported that 34 of 35 respon-
dents (97%) used either DBEs or cough in the
management of routine postoperative CABG patients,
compared to 77% of respondents in the current study.
This finding suggests in the past 14 years there has
been a reduction in the implementation of breathing
exercises. While this is a positive development, over
three quarters of respondents in the current study
were still using these techniques despite mounting evi-
dence of no benefit. This is a greater percentage than
expected, considering the increased emphasis on evi-
dence-based practice and the increased accessibility
of literature via the Internet and other electronic
sources over the past decade. However, these findings
are consistent with research suggesting that 30–40% of
patients do not receive treatments of proven effectiveness
and that 20–25% have treatments that are unnecessary
or potentially harmful (Grol, 2001; McGlynn, Asch,
and Adams, 2003). It should be acknowledged that
although the application of techniques such as breath-
ing exercises and incentive spirometry have not been
shown to be beneficial, there is no evidence that
these treatments are of any harm to patients. This
may contribute to their persistence in clinical practice.
Of all literature identified as being influential by our
respondents, articles on DBEs were featured most
frequently (n = 19). However, 63% (n = 12) of these
respondents reported using DBEs as a routine post-
operative intervention, despite being aware of research
evidence suggesting these interventions are not ben-
eficial. This finding suggests that the ability to identify
relevant literature does not ensure the application
of literature recommendations to current practices.
Other significant factors besides literature are influen-
cing physiotherapy treatment choices. Previously
documented barriers to implementation of evidence
in physiotherapy practice include lack of time,
limited access to publications, lack of education, and
low self-efficacy in undertaking evidence-based prac-
tices (Fruth et al, 2010; Iles and Davidson, 2006;
Jette et al, 2003; Salbach et al, 2007).
A clinical care pathway (implemented at 91% of
hospitals in the current study) is a method of standar-
dising and improving patient care and lowering health
care costs (Fox and Brown, 1999). Flarey and Blancett
Copyright © Informa Healthcare USA, Inc., USA, Inc.

(1998) developed and implemented a clinical care
pathway for uncomplicated CABG patients. Prior to
implementing the pathway they found a great degree
of variability in practice between staff and variations
in the way standards of care were interpreted and
implemented. Their motive for the implementation
of a care pathway was its ability to facilitate consensus
of best practices among health professionals, promot-
ing consistency. However, our study shows that consist-
ency does not guarantee best practices. The majority of
respondents (91%) followed a clinical care pathway,
but a large portion of these implemented non-evi-
dence-based practices such as DBEs or IS. Clinical
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pathway use did not increase or decrease the likelihood
of a hospital using DBEs. If a clinical care pathway has
been in place for a period of time, it may fail to reflect
the most current literature. Frequent review of hospital
protocols is necessary to ensure pathways are based on
current evidence.
Respondents with a bachelor or diploma in
physiotherapy were more likely to implement breath-
ing techniques or coughing than physiotherapists
with a postgraduate degree ( p = 0.045). Physiothera-
pists who have undertaken further study may be
For personal use only.
more inclined to use evidence-based practice, which
may be related to their expanded knowledge obtained
during further studies or extensive research skills
gained while undertaking a postgraduate degree. Iles
and Davidson (2006) found that physiotherapists
with higher levels of training were more confident in
their ability to search databases and did so more fre-
quently than physiotherapists with lower levels of
training. This finding highlights the important role
postgraduate study can play in introducing and imple-
menting evidence-based practices. Given that the re-
spondents to this survey were all senior cardiothoracic
physiotherapists who were providing leadership in the
management of CABG patients, efforts should be
made to ensure that senior staff members have access
to ongoing training.
While the impact of postgraduate training on ability
to use research evidence is encouraging, the role of
undergraduate training in preparation for evidence-
based practice requires examination. Literature
suggests that newer graduates have an increased con-
fidence in research skills and the theory surrounding
evidence-based practice than their more experienced
colleagues, yet previously they have been shown to
implement evidence-based treatments less frequently
than more senior physiotherapists (Iles and Davidson,
2006; Jette et al, 2003). The acquisition of academic
skills related to evidence-based practice may not be
sufficient to ensure their application during pro-
fessional practice. Recent studies suggest that it may
be possible to train students in the application of
Physiotherapy Theory and Practice
Physiotherapy Theory and Practice 183
evidence to practice within the undergraduate curri-
culum, through partnerships between students and
their clinical teachers. Nursing students were success-
fully taught the skills to implement best practices in a
clinical setting by addressing real practice issues that
had been identified by clinicians (Schmidt and
Brown, 2007). Students searched the literature, ana-
lysed the evidence, determined best practice based
on the evidence, and developed a policy for
implementation in the clinical setting. Similarly, en-
gagement in an evidence-based practice cycle by stu-
dents and their mentors in a specific practice area
improved students’ skills and knowledge and was per-
ceived to be of value by students and mentors (Morris
and Maynard, 2009). Such strategies may also prove
to be of value in this challenging area of physiotherapy
education.
Respondents perceived the main influences on
their treatment choices to be personal experience
(87%) and literature (75%). This finding is consistent
with the findings of Tucker et al (1996), who reported
that personal experience had a greater perceived influ-
ence than literature or other alternatives on treatment
regimens. Similarly, a survey of Australian and British
physiotherapists found that choice of treatment tech-
niques was strongly influenced by the effects of treat-
ment on prior patients, whereas research literature was
the least important influence (Turner and Whitfield,
1997). The importance of clinical experience is ac-
knowledged in models of evidence-based practice,
where it is crucial to balancing the patient’s clinical
state and circumstances with relevant research evi-
dence as well as the patient’s preferences and actions
(Haynes, Devereaux, and Guyatt, 2002). Data from
this and previous studies suggest that some clinicians
may have difficulty balancing these demands, which
at times may be competing. Physiotherapy education
must ensure that clinicians have the skills necessary
to successfully integrate these crucial elements into
clinical decision making.
To implement change toward evidence-based prac-
tice within a health care setting we must first identify
potential barriers and promoters for change. Possible
barriers to adopting best practice guidelines include a
lack of knowledge, motivation, social norms, and poor
leadership (Grol and Wensing, 2004). To implement
evidence-based practice Grol and Grimshaw (2003)
recommended preparation, involving relevant
people, developing an evidence-based proposal for
change that is both attractive and feasible, studying
the main barriers to achieving change, and selecting
a set of strategies and measures. In addition to train-
ing in the skills necessary to apply evidence to clinical
practice, Australian and New Zealand physiothera-
pists may benefit from a set of standardised,
 184 Filbay et al.
evidence-based guidelines for use on routine, uncom-
plicated CABG patients. These guidelines would
make specific recommendations regarding physiother-
apy management and the strength of evidence on
which they are based. Rigorous preparation and evalu-
ation of guidelines are required to ensure that the evi-
dence used is of high quality and the clinical
guidelines produce strong recommendations (Guyatt
et al, 2008).
There are a number of limitations to this study.
First, the questionnaire used was designed specifically
for this project and had undergone only limited pilot
testing. Although we aimed to collect information
Physiother Theory Pract Downloaded from informahealthcare.com by McMaster University on 11/04/14
that could be directly compared to that of Tucker
et al (1996), it is possible that some differences
could have arisen because of the different survey in-
struments used. Second, only the most senior cardi-
othoracic physiotherapist in each institution was
invited to participate in the study. We chose this strat-
egy to ensure that only one response was received from
each institution, thus ensuring that the practices of
smaller and larger hospitals were equally represented.
However, it is possible that the responses of the
senior physiotherapist did not reflect all physiotherapy
For personal use only.
practice within their institution. Finally, this study col-
lected information regarding self-reported physiother-
apy practice for treatment of patients following CABG
surgery. It is possible that physiotherapists answered
in a manner they thought represented acceptable prac-
tice, despite the anonymous nature of the question-
naire, and thus our results may not reflect the
treatments actually delivered.
CONCLUSION
Deep breathing exercises and incentive spirometry are
commonly used in physiotherapy management of
patients following uncomplicated CABG surgery in
Australian and New Zealand hospitals, despite re-
search evidence indicating these treatments are of no
benefit. Physiotherapists with a postgraduate degree
were significantly less likely to implement deep breath-
ing exercises or coughing than respondents with a ba-
chelor or diploma degree. Physiotherapists were able
to identify relevant literature, but in many cases this
did not appear to influence practice. In line with
current evidence, mobilisation was frequently used
for patients following CABG surgery in Australian
and New Zealand hospitals. Despite this, some prac-
tices that are not based on best available evidence
persist. These results suggest a pressing need to
develop and test strategies to embed evidence-based
treatment into the physiotherapy management of
patients following CABG.
Declaration of Interest: The authors report no
conflicts of interest. The authors alone are responsible
for the content and writing of the article.
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 186 Filbay et al.
APPENDIX 1. Is the physiotherapy
management of patients following coronary
artery bypass graft surgery based on current
evidence? A survey of current practice
Questionnaire:
Please note the following abbreviations appear
throughout the questionnaire:
Active controlled breathing technique (ACBT),
Intermittant positive pressure breathing (IPPB),
Bilevel intermittent positive airway pressure (BIPAP),
Continuous positive airway pressure (CPAP),
Physiother Theory Pract Downloaded from informahealthcare.com by McMaster University on 11/04/14
Positive expiratory pressure (PEP),
Coronary artery bypass graft surgery (CABG).
Service Provision:
1. Do you work in a public or private hospital?
□ Public □ Private
2. Which geographical area do you work in?
□ Victoria □ New South Wales □ Queensland
□ Tasmania □ Western Australia □ Australian
For personal use only.
Capital Territory
□ South Australia □ Northern Territory □ New
Zealand
3. How many years have you been working as a
physiotherapist?
□ <1 year □ 1–3 years □ 4–6 years □ 7–9 years
□ 10–12 years □ >12 years
4. How many years have you been working in the
area of cardiothoracic surgery?
□ <1 year □ 1–3 years □ 4–6 years □ 7–9 years
□ 10–12 years □ >12 years
5. Please tick the response below that best de-
scribes the highest level of university education
that you have completed.
□ Diploma of Physiotherapy
□ Bachelor of Physiotherapy/Graduate Entry
Masters in Physiotherapy
□ Postgraduate diploma
□ Postgraduate Masters of Physiotherapy by
coursework
□ Postgraduate Masters of Physiotherapy by
research
□ PhD/Doctorate of Physiotherapy
□ Other (please specify). . . . . . . . . . . . . . . . . .
6. On average, how many patients undergo coron-
ary artery bypass graft surgery (CABG) per week
in your unit?
Please specify: . . . . . . . . . . . . patients per week.
7. What is the average length of postoperative stay
for patients undergoing uncomplicated CABG
surgery?
Please specify: . . . . . . . . . . . . . . . . . . . day(s).
8. Which of the following CABG patients are as-
sessed preoperatively by a physiotherapist?
□ All non-emergency CABG patients
□ Only high-risk CABG patients are assessed pre-
operatively by a physiotherapist
□ CABG patients are not assessed preoperatively
by a physiotherapist
Postoperative Physiotherapy Management:
9. Are all patients seen postoperatively by a
physiotherapist?
□ Yes □ No
10. Which of the following statements most accu-
rately reflects the physiotherapy management
following CABG surgery in your unit?
□ Physiotherapists are not involved in the assess-
ment or treatment of patients following CABG
surgery
□ Physiotherapists do not assess or treat any
patients routinely postoperatively but accept re-
ferrals to physiotherapy by other members of the
medical team when necessary
□ All patients are assessed by physiotherapists, but
interventions are only instituted when deemed
necessary by the physiotherapist (i.e., not all
patients receive treatment.)
□ All patients are assessed by physiotherapists and
receive prophylactic/preventative interventions
(i.e., all patients are treated.)
Other? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
....................................
11. At what stage are patients first visited by the
physiotherapist postoperatively?
□ Day of operation □ 1st postoperative day
Other? ……
12. Are uncomplicated patients routinely treated
by a physiotherapist prior to extubation in an
intensive care unit (ICU)?
□ Yes □ No
……If yes, what type of treatment is performed
prior to extubation in ICU (please tick as many
boxes as appropriate)?
Positioning □ Manual Hyperinflation □
Suctioning □ Ventilator Hyperinflation □
Other? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Copyright © Informa Healthcare USA, Inc., USA, Inc.
 Physiotherapy Theory and Practice 187

13. In what location are patients normally nursed 18. Please rank how much each of the following
immediately following surgery (i.e., postrecovery)? influence your postoperative practice (circle
□ ICU □ Hospital day unit (HDU) □ Cardiac ward one number for each).
Other? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No Somewhat Moderately Very
14. Is the postoperative management of patients Influence Influential Influential Influential
undergoing uncomplicated CABG surgery in
Personal 1 2 3 4
your unit, guided by a clinical care pathway?
experience
□ Yes □ No Literature 1 2 3 4
15. How often per day do you review uncompli- recomme-
cated CABG patients? ndations
□ 0 x per day □1 x per day □ 2 x per day □ 3 or more Medical 1 2 3 4
Physiother Theory Pract Downloaded from informahealthcare.com by McMaster University on 11/04/14

x per day colleagues

preferences
16. In uncomplicated/routine CABG surgery Resource/ 1 2 3 4
patients, without any signs of a postoperative financial
pulmonary complication, which of the follow- consideration
ing treatment interventions do you routinely Established 1 2 3 4
practice
incorporate in your treatment program
Peer pressure 1 2 3 4
(please tick one box for each treatment Contractual 1 2 3 4
intervention)? obligation
Breathing exercises □ ACBT □ Public/private 1 2 3 4
Incentive Spirometry □ IPPB/BIRD □ hospital
BIPAP/ CPAP □ PEP □ patient
For personal use only.

Progressive mobilisation □ Cough □ Other 1 2 3 4

Upper limb and trunk range
of motion exercises □ Cardiovascular If you answered other above, please specify what that is.
exercise □ 19. Which literature (if any) has influenced your
physiotherapy management of patients follow-
17. Which of the following procedures are per- ing CABG surgery? Please be as specific as
formed, by whom, and commencing on possible, including names of authors, title of
which postoperative day (please tick either publication, year of publication.
physio or nurse based on who performs this
activity on the majority of occasions)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Not routinely Postop
Physio Nurse undertaken day
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sitting out of Bed □ □ □ ......
Walking □ □ □ ......
Upper limb and □ □ □ ......
trunk range of
motion
exercises
Stair climbing □ □ □ ......
Home Exercise □ □ □ ......
program
Assessment of □ □ □ ......
sternal wound
stability

Physiotherapy Theory and Practice