1.A scoping review of operative limb dysfunction assessment and early functional exercise after cardiac implantable electronic device placement
Cuimei SHAO ; Fei ZHAO ; Jieying CHEN
Chinese Journal of Practical Nursing 2024;40(25):1992-2001
Objective:To conduct a scoping review of studies on the assessment content and early functional exercise of various functional disorders occurring in the limbs on the operated side after cardiac implantable electronic device implantation, so as to provide a reference for the future early identification of different functional disorders in the limbs on the operated side and the guidance of early rehabilitation and exercise in the postoperative period.Methods:According to the scoping review methodology,we systematically searched PubMed, Embase, Cochrane Library, Web of Science, CINAHL, CNKI, VIP, Wanfang and CBM. The retrieval time limit was from the establishment of the database to October 31, 2023. The included studies were summarized and analyzed.Results:Totally 15 studies were included. These included 7 randomized controlled trials and 6 cohort studies, and 2 case-control studies. Postoperative series of limb-related dysfunction on the operative side after cardiac implantable electronic device implantation including shoulder pain, limited range of motion of the shoulder, decreased grip strength, and scapular dyskinesia. Shoulder range of motion limitations included flexion, abduction, and internal and external rotation angle limitations. Shoulder pain and impaired active forward flexion had the highest prevalence, reaching 61% and 60% respectively. The most restricted population was ICD implanted patients. The assessment tools included subjective and objective tools. These tools included 3 types of scales to assess shoulder pain and goniometer for assessing shoulder range of motion and hydraulic hand dynamometer for evaluating grip strength, and tests and tape measures to assess scapular dyskinesia and 5 types of scales to assess overall limb function on the operative side.The various dysfunctions associated with the limb on the operated side basically appeared at 2 weeks postoperatively, and these dysfunctions began to improve at 3 months postoperatively and normalized at 12 months and fully recovered at 5 years.The longest duration was in patients with ICD implants. The rehabilitation exercise program consisted of five types, of which the pendulum exercise was a single program and the remaining four were comprehensive rehabilitation exercise programs, all of which were effective.Intervention time points included postoperative days 1 and 2, as well as postoperative weeks 1 and 2.Conclusions:We need to focus on the presence of serial related dysfunction in the operated limb after cardiac implantable electronic device implantation. Assessment tools are diverse and we need to choose appropriately based on measurement priorities. All of these dysfunctions are self-limiting, however, they still have a long time to heal themselves. All of these individuals need to be included in screening and comprehensive interventions at regular outpatient follow-up visits for one year after surgery. Conducting a comprehensive functional exercise program is beneficial in reducing the incidence and duration of different dysfunctions in the patient′s operated limb. These exercise programs have value for further clinical application. However, these exercise programs are not uniform.In order to provide early intervention for patients, the further validation of which types of activity programs or a combination of certain types of activity programs need to be further investigated. The timing of early functional exercise is not uniform and further work is needed to determine these times.
2.Best evidence application of exercise prescriptions for patients with chronic heart failure
Lili ZHOU ; Ge GUO ; Mei LI ; Cuimei SHAO ; Yue MAO ; Beibei ZHU ; Jia FENG ; Hailian CHEN ; Jianping SONG
Chinese Journal of Nursing 2024;59(14):1698-1705
Objective To investigate the best evidence application of exercise prescription in patients with chronic heart failure in clinical practice and evaluate its effectiveness.Methods The best evidence of exercise prescription for patients with chronic heart failure was summarized,and the evidence-based practice plan was developed,and it was implemented in the cardiology department of a tertiary hospital in Zhejiang Province from August to October,2022.Nurses'exercise prescription knowledge-attitude-practice level,implementation rate of review indicators,the length of hospital stay,exercise endurance,daily living ability and grip strength of both groups before and after the intervention were compared.Results After the application of the best evidence,the score of knowledge dimension was(9.34±0.98)points;the score of attitude dimension was(63.29±1.37)points;the score of practice dimension was(25.49±1.51)points,which were statistically significant compared with the scores before the application of evidence(P<0.05).After the application of the best evidence,the implementation rate of 16 review indicators was higher than that before the application of evidence(P<0.001).The length of hospital stay in the evidence application group was shorter than that in the baseline examination group(Z=-2.610,P<0.001).After intervention,the exercise endurance,daily living ability and grip strength of patients in the evidence application group were improved compared with the baseline review group,and the difference was statistically significant(P<0.05).Conclusion After the application of the best evidence of exercise prescription in patients with chronic heart failure,it can improve the level of knowledge,attitude and practice of nurses on exercise prescription,standardize the compliance of nurses'exercise prescription,reduce the number of days in the hospital,and improve patients'exercise endurance,daily living ability and grip strength.