Low-level laser therapy versus trunk stabilization exercises on sternotomy healing after coronary artery bypass grafting: a randomized clinical trial.

The aim of this study was to investigate the effects of low-level laser therapy (LLLT) versus trunk stabilization exercises on sternotomy healing following coronary artery bypass grafting (CABG) surgery. Forty-five male patients who had acute sternal instability post-CABG surgery in the age range of 45-65 years were divided randomly into three equal groups (n = 15). The laser group received LLLT, while the exercise group received trunk stabilization exercises. The control group only received a routine cardiac rehabilitation programme, which was also provided to both the laser and the exercise groups. All groups were offered 12 sessions over 4 weeks. Sternal separation, median sternotomy photographic analysis, pain and activities of daily living (ADL) performance were evaluated pre- and post-treatment. Statistical significance was set at P < 0.05. There was a significant decrease among the laser group in upper-sternal separation, while the exercise and control groups showed a non-significant decrease. In terms of mid-sternal separation, laser and exercise groups showed a significant decrease while the control group showed a non-significant decrease. In terms of lower-sternal separation, the exercise group showed a significant decrease, while the laser and control groups showed a non-significant decrease. Post-treatment between-groups analysis showed a significant difference only among the laser and control groups with regard to upper-sternal separation, while analysis of the laser, exercise and control groups in the case of upper-sternal separation and the between-groups comparison in terms of mid- and lower-sternal separation revealed no significant differences. LLLT and trunk stabilization exercises were found to be the most effective methods for sternotomy healing post-CABG surgery, with LLLT offering superior performance in the case of the upper sternum while trunk stabilization exercises were more effective for the lower sternum.

Comparative study of two different respiratory training protocols in elderly patients with chronic obstructive pulmonary disease.

AIM: The aim of the present study was to compare threshold inspiratory muscle training (IMT) and expiratory muscle training (EMT) in elderly male patients with moderate degree of COPD. MATERIALS AND METHODS: Forty male patients with moderate degree of COPD were recruited for this study. They were randomly divided into two groups: the IMT group who received inspiratory training with an intensity ranging from 15% to 60% of their maximal inspiratory pressure, and the EMT group who received expiratory training with an equal intensity which was adjusted according to the maximal expiratory pressure. Both groups received training three times per week for 2 months, in addition to their prescribed medications. RESULTS: Both IMT and EMT groups showed a significant improvement in forced vital capacity, forced expiratory volume in the first second, forced expiratory volume in the first second% from the predicted values, and forced vital capacity% from the predicted value, with no difference between the groups. Both types of training resulted in a significant improvement in blood gases (SaO2%, PaO2, PaCO2, and HCO3), with the inspiratory muscle group showing the best results. Both groups showed a significant improvement in the 6-min walking distance: an increase of about 25% in the inspiratory muscle group and about 2.5% in the expiratory muscle group. CONCLUSION: Both IMT and EMT must be implemented in pulmonary rehabilitation programs in order to achieve improvements in pulmonary function test, respiratory muscle strength, blood oxygenation, and 6-min walking distance.