The purpose of this study was to determine whether gait speed can be used to guide discharge disposition recommendations from acute care in patients following median sternotomy open heart surgery.
Gait speed was measured in 59 patients aged 44 to 90 years on the cardiac surgery step-down unit of a 502-bed teaching hospital. Subjects were post median sternotomy, coronary artery bypass graft (CABG), valve(s) repair/replacement, or CABG, and valve(s). Comfortable walking speed was measured using a digital stopwatch in a single trial over a 2.4 m (8 feet) path with additional 1.5 m (5 feet) of acceleration and deceleration. Assistive walking devices and oxygen were utilized as needed.
A total of 59 patients, mean age males 67.3 ± 10.3 years, females 67.7 ± 11.5 years; patients were 32 CABG, 18 valve repair/replacement(s), and 9 CABG + valve(s) repair/replacement. Mean gait speed for males was 0.37 m/s, and for females was 0.24 m/s (P = .004). Twenty patients were discharged to acute rehabilitation, mean gait speed 0.25 m/s, 10 to subacute rehabilitation (SAR), mean gait speed 0.25 m/s, and 29 to home, mean gait speed 0.42 m/s. Comparisons between acute and home disposition demonstrated a mean gait speed difference of −0.181 m/s (P = .000), and SAR and home −0.171 m/s (P = .07). Comparisons between fast and slow walkers were done on the basis of a cut-point previously determined in the literature of 0.4 m/s and demonstrated a correlation coefficient 0.587 between the use of an assistive device and slow gait speed.
Slow walkers were more likely to be discharged to rehabilitation. Patients using an assistive device were more likely to have slower gait speed and subsequent discharge to rehabilitation. The best predictor of slow gait speed was the use of an assistive walking device. Gait speed is a measure easily performed in the acute care setting and can effectively guide discharge disposition recommendations from acute care in patients following median sternotomy open heart surgery.