Fuller Louise M, El-Ansary Doa, Button Brenda, Bondarenko Janet, Marasco Silvana, Snell Greg, Holland Anne E
a Physiotherapy Department Victoria , The Alfred Hospital Melbourne , Australia.
b Discipline of Physiotherapy , La Trobe University , Bundoora , Victoria Australia.
Physiother Theory Pract. 2018 Dec;34(12):931-934. doi: 10.1080/09593985.2018.1431342. Epub 2018 Jan 25.
A surgical incision for bilateral sequential lung transplantation (BSLTX) is the "clam shell" (CSI) approach via bilateral anterior thoracotomies and a transverse sternotomy to allow for sequential replacement of the lungs. This can be associated with significant post-operative pain, bony overriding or sternal instability. The sternal instability scale (SIS) is a non-invasive manual assessment tool that can be used to detect early bony non-union or instability following CSI; however, its reliability is unknown.
This prospective blinded reliability study aimed to assess intra-rater and inter-rater reliability of the SIS following lung transplantation.
Participants post BSLTX aged older than 18 years underwent sternal assessment utilizing the SIS. Two assessors examined the sternum using a standardized protocol at two separate time points with a test-re-test time of 48 hours. The outcome measure was SIS tool using four categories from 0 (clinically stable) to 3 (separated sternum with overriding).
In total, 20 participants (75% female) with a mean age of 48 years (SD 17) and mean pain score of 3 out of 10 were included, 60% having well healed wounds and 25% reporting symptoms of sternal clicking. The most painful self-reported painful activity was coughing. The SIS demonstrated excellent reliability with a kappa = 0.91 by different assessors on the same day, and kappa = 0.83 for assessments by the same assessor on different days.
The SIS is a reliable manual assessment tool for evaluation of sternal instability after CSI following BSLTX and may facilitate the timely detection and management of sternal instability.
双侧序贯肺移植（BSLTX）的手术切口是通过双侧前开胸和横向胸骨切开术的“蚌壳式”（CSI）入路，以便序贯更换肺部。这可能会伴有严重的术后疼痛、骨重叠或胸骨不稳定。胸骨不稳定量表（SIS）是一种非侵入性手动评估工具，可用于检测CSI术后早期的骨不愈合或不稳定；然而，其可靠性尚不清楚。
这项前瞻性双盲可靠性研究旨在评估肺移植后SIS的评估者内和评估者间可靠性。
年龄超过18岁的BSLTX术后参与者接受了SIS胸骨评估。两名评估者按照标准化方案在两个不同时间点检查胸骨，重测时间为48小时。结果测量采用SIS工具，分为0（临床稳定）至3（胸骨分离伴重叠）四类。
共纳入20名参与者（75%为女性），平均年龄48岁（标准差17），平均疼痛评分为10分中的3分，60%的伤口愈合良好，25%报告有胸骨弹响症状。自我报告最疼痛的活动是咳嗽。SIS显示出极好的可靠性，同一天不同评估者的kappa值为0.91，同一评估者不同天评估的kappa值为0.83。
SIS是一种可靠的手动评估工具，用于评估BSLTX后CSI术后的胸骨不稳定，可能有助于及时发现和处理胸骨不稳定。
