ELK Progressive Warm-up Sequence as an Operational Definition of Early Mobility and Predictor of Maximal Independent Gait After Sternotomy
Emily Lynn KavanaughABSTRACT
Background:
Early mobilization after cardiac surgery is associated with improved recovery; however, the specific physical therapy interventions that optimize early gait performance remain poorly defined. Although early activity is widely recommended, little research has examined how structured preambulation strategies may influence functional outcomes. The Kavanaugh Progressive Warm-Up (KPW) Sequence was developed as a novel clinical protocol and was compared with usual therapist-directed mobilization in this study.
Methods:
A retrospective case-control study was conducted in the cardiovascular and thoracic intensive care unit at Reid Heart Center, Moore Regional Hospital. Electronic medical record data from patients who underwent sternotomy between January 1, 2018, and December 31, 2023, were analyzed. Patients treated by 1 of 3 cardiac surgeons were included. Outcomes extracted from the initial postoperative physical therapy session included gait distance, evaluation duration, discharge disposition recommendation, and total number of physical therapy sessions required to meet discharge goals.
Results:
Of 1614 eligible patients, 712 received therapist-directed mobilization and 902 received the KPW Sequence on postoperative day 1. After exclusion criteria were applied, 696 patients remained in the usual care group and 879 remained in the KPW Sequence group for comparison. Evaluation duration was longer in the KPW Sequence group (41.98 vs 31.62 minutes;
Discussion:
Use of the KPW Sequence, a standardized preambulation warm-up protocol, was associated with greater initial gait performance, fewer total physical therapy sessions, and more independent discharge recommendations compared with usual therapist-directed mobilization in patients following sternotomy. These findings suggest that structured preambulation preparation may influence functional performance and discharge planning during early poststernotomy mobilization.