{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:13:14Z","timestamp":1787242394929,"version":"build-2736575974"},"reference-count":16,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2021,3,22]],"date-time":"2021-03-22T00:00:00Z","timestamp":1616371200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&R"],"published-print":{"date-parts":[[2021,12]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Restrictive sternal precautions intended to prevent cardiac surgery patients from damaging healing sternotomies lack supporting evidence and may decrease independence and increase postacute care utilization. Data regarding the impact of alternative approaches on safety and outcomes are needed to guide evidence\u2010based best practices.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine whether an approach allowing greater freedom during activities of daily living than permitted under commonly used restrictive sternal precautions can safely decrease postacute care utilization.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Before\u2010and\u2010after study, using propensity score adjustment to account for differences in patient clinical and demographic characteristics, surgery type, and surgeon.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n 600\u2010bed acute care hospital.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Beginning March 2016, the acute care hospital replaced traditional weight\u2010 and time\u2010based precautions given to patients who underwent median sternotomy with the \u201cKeep Your Move in the Tube\u201d (KMIT) approach for mindfully performing movements involved in the activities of daily living, guided by pain.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measures<\/jats:title>\n \n The study compared sternal wound complications, discharge disposition, 30\u2010day readmission, and functional status between consecutive cardiac surgery patients with \u201cindependent\u201d or \u201cmodified independent\u201d preoperative functional status who underwent median sternotomy in the 1.5\u2009years before (\n n<\/jats:italic>\n \u00a0=\u2009627, standard precautions group) and after (\n n<\/jats:italic>\n \u00a0=\u2009477, KMIT group) KMIT implementation.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The odds of discharge to home, versus to inpatient rehabilitation or skilled nursing facility, were ~3 times higher for KMIT than standard precautions patients (risk\u2010adjusted odds ratio [rOR], 95% confidence interval [CI]\u2009=\u20092.90, 1.95\u20134.32, and 3.03, 1.57\u20135.86, respectively). KMIT patients also had significantly higher odds of demonstrating \u201cindependent\u201d or \u201cmodified independent\u201d functional status on final inpatient physical therapy treatment for bed mobility (rOR, 95% CI\u2009=\u20097.51, 5.48\u201310.30) and transfers (rOR, 95% CI\u2009=\u20093.40, 2.62\u20134.42). No significant difference was observed in sternal wound complications (in\u2010hospital or causing readmission) (rOR, 95% CI\u2009=\u20091.27, 0.52\u20133.09) or all\u2010cause 30\u2010day readmissions (rOR, 95% CI\u2009=\u20090.55, 0.23\u20131.33).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n KMIT increases discharge\u2010to\u2010home for cardiac surgery patients without increasing risk for adverse events and reducing utilization of expensive institutional postacute care.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/pmrj.12562","type":"journal-article","created":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T17:45:38Z","timestamp":1612374338000},"page":"1321-1330","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["\u201c\n Keep Your Move in the Tube<\/scp>\n \u201d safely increases discharge home following cardiac surgery"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2583-9577","authenticated-orcid":false,"given":"Richard","family":"Gach","sequence":"first","affiliation":[{"name":"The Acute Therapy Department Memorial Regional Hospital Hollywood Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Triano","sequence":"additional","affiliation":[{"name":"The Acute Therapy Department Memorial Regional Hospital Hollywood Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald O.","family":"Ogola","sequence":"additional","affiliation":[{"name":"Center for Clinical Effectiveness Baylor Scott & White Health Dallas Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Briget","family":"da Graca","sequence":"additional","affiliation":[{"name":"Center for Clinical Effectiveness Baylor Scott & White Health Dallas Texas"},{"name":"Robbins Institute for Health Policy & Leadership Baylor University Waco Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Shannon","sequence":"additional","affiliation":[{"name":"The Acute Therapy Department Memorial Regional Hospital Hollywood Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doa","family":"El\u2010Ansary","sequence":"additional","affiliation":[{"name":"Department of Surgery, Melbourne Medical School The University of Melbourne Melbourne Australia"},{"name":"School of Health and Biomedical Sciences Swinburne University of Technology Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Bilbrey","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Department Baylor Hamilton Heart and Vascular Hospital Dallas Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Cortelli","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery Memorial Regional Hospital Hollywood Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Adams","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Department Baylor Hamilton Heart and Vascular Hospital Dallas Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,22]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Healthcare Cost and Utilization Project (HCUP) Statistical Briefs","author":"Weiss AJ","year":"2006"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01823246-201122010-00002"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.136.4_MeetingAbstracts.98S"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jphys.2018.02.013"},{"key":"e_1_2_7_6_1","volume-title":"Skeletal Muscle Structure, Function, and Plasticity: The Physiological Basis of Rehabilitation","author":"Lieber 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