The effect of osteopathic manipulative treatment on postoperative medical and functional recovery of coronary artery bypass graft patients

Participants

• Number: 53 people (13 female and 40 male)
• Criteria of inclusion: voluntary, age 18-80 years, an osteopathic cardiovascular surgeon’s patients who had to undergo aorto-coronary bypass graft
• Criteria of exclusion: past aorto-coronary bypass surgery, unstable psychiatric disease, unstable chronic pain, open chest phenomenon, sudden peri- or post-operative complications
• Groups of study: three groups obtained by randomization
  • Group 1: standard care with OMT, 17 people (4 female and 13 male, mean age 65,1 years)
  • Group 2: standard care with sham treatment, 18 people (5 female and 13 male, mean age 67,0 years)
  • Group 3: standard care, 18 people (4 female and 14 male, mean age 63,3 years)

Interventions and evaluations

• Medical data collected by a FIM certified physiotherapist
  • among the data collected: date of the coronary artery bypass graft operation, number of blood vessels bypassed, date of extubation, surgical complications, total length of hospital stay, days of post-surgery hospital stay, supplemental oxygen need, date of first bowel movement, distance walked, use of analgesics
• Assessment of the person’s functional independence through FIM
  • a scale from 1 to 7 to assess the ability of grooming, toileting, transfers and walking
  • in the study were analyzed FIM data only until the third day, since from the fourth day the discharges began
• 1 daily treatment from the day after the operation until discharge
• 8 minutes OMT or surface handling
• OMT: thoracic inlet myofascial release, rib raising (with paraspinal muscle stretch to L2) and soft muscle techniques at cervical level (with paraspinal muscle stretch and suboccipital muscle release)
  • techniques chosen to regulate the orthosympathetic and parasympathetic nervous systems and improve both lymphatic drainage and chest mobility
• Sham treatment: light touch applied to the same regions treated in the OMT, without moving the myofascial structures
• OMT performed by an osteopathic physician or by an osteopathic medical student under the supervision of a physician co-author of the study
• Pre-study training to perform the osteopathic techniques as well as the sham techniques in a standardized manner

Results

Primary outcomes: compared to the two control groups (standard care and standard care with the addition of sham treatment), the group that received standard care with the addition of OMT reported slightly better results both in the time of hospitalization until discharge and in the time elapsed before the resumption of bowel movements (both lower).

As for functional independence, on the third day the group with OMT showed a score higher than that of the other two groups according to the FIM scale (19.3 vs 15.4 vs 18.6). However, as with the other results, the statistical significance was not reached.

Discussion

Following a coronary artery bypass graft surgery, often remains a preponderance of the orthosympathetic activity that can affect the intestinal activity. Moreover, given the nervous and myofascial connections, cardiovascular health is particularly affected by the state of the musculoskeletal system. OMT, through different techniques, can act on both muscular and nervous aspects to promote good cardiovascular functionality.
The results obtained show a potentiality of OMT in this sense. However, more organized studies are needed to better assess the actual extent of this potential.