The aims of this study were to conduct a preliminary scoping survey of existing practice related to exercise and functional recovery following median sternotomy for cardiac surgery; and to evaluate the implementation of KMIT® across 4 acute surgical and 35 outpatient CR services in Australia utilising the 'Knowledge to Action framework'.
This study was a prospective, longitudinal, pre-post intervention design, using the RE-AIM framework for evaluation. The project was undertaken in four main phases: i) a scoping survey to describe CR practice ii) development, and co-design of an implementation strategy to standardise education and exercise training following median sternotomy, iii) implementation, and iv) evaluation of the implementation strategy. All staff with a clinical role associated with managing patients post median sternotomy surgery, were invited to complete three, purpose-built surveys throughout the project, all of which were distributed by the change champions at each site.
The research translation framework identified a structured process to co-design, develop, and implement a tailored implementation strategy acknowledging local context, barriers and enablers to implementation and optimised sustainability. It included providing access to KMIT® teaching resources, development and implementation of education and training tools, and centralised project management to aid change champions to act locally at acute and outpatient CR settings.
The scoping survey demonstrated inconsistent post-operative practice across CR, with variable knowledge and implementation of KMIT®. Thirty-nine education and training sessions were delivered by change champions, reaching a total of 366 clinicians. Familiarity with KMIT® improved from 11% to 76% following education and training. However, some uncertainty remained, with 25% of clinicians incorrectly believing KMIT® provided time restrictions on loaded upper limb activities and 16% of clinicians incorrectly believing that KMIT® provided load limits to upper limb activities. 88% reported integrating KMIT® into their clinical practice, an increase from 23% at baseline. Overall adoption and acceptability were met with very high, consistent agreement amongst clinicians.
This study has demonstrated a successful strategy for translating the KMIT® evidence into practice which could be modelled within other countries globally. Additional work is required to address persisting knowledge gaps regarding time and load restrictions.
The “Knowledge to Action Framework” can be used to effectively translate evidence such KMIT® into practice to facilitate recovery and optimal patient outcomes following cardiac surgery.
exercise
research translation
