Reliability of sternal instability scale (SIS) for transverse sternotomy in lung transplantation (LTX)

AuthorsFuller, L.M.
El-Ansary, D.
Button, B.
Bondarendko, J.
Marasco, S.
Snell, G
Holland, A.E.
TypeJournal Article (Original Research)
JournalPhysiotherapy Theory and Practice
PubMed ID29369002
Year of Publication2018
Download Reliability_of_sternal_instability_scale_SIS_for_transverse_sternotomy_in_lung_transplantation_LTX.pdf (661.9 KB)
AbstractA 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. OBJECTIVE: This prospective blinded reliability study aimed to assess intra-rater and inter-rater reliability of the SIS following lung transplantation. METHOD: 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). RESULTS: 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. CONCLUSION: 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.

< More publications


Each year in Australia 260 people sustain a SCI, with over half losing full function in their arms and legs (quadriplegia). In addition to the primary disability, there is a very high rate of Obstructive...

Notch monitoring in sleepNOTCH MONITORING IN SLEEP

Sleep apnea is a condition where breathing is abnormal during sleep. There are two main forms of sleep apnea: obstructive and central. For obstructive sleep apnea, breathing is reduced because the airway...

IBAS Director Anna Burke unveiling of her portrait at Canberra's Parliament HouseIBAS DIRECTOR ANNA BURKE UNVEILING OF HER PORTRAIT AT CANBERRA'S PARLIAMENT HOUSE

Anna Burke had barely got into the swing of her speech at the unveiling of her portrait at Canberra's Parliament House when the ringing of bells caused half her audience to hurry away

Thunderstorm asthma expected to return in 2017THUNDERSTORM ASTHMA EXPECTED TO RETURN IN 2017

The Morning Show - Thunderstorm asthma expected to return in 2017. The Daily Edition - Thunderstorm Asthma is an unexpected killer. Better Health Channel - Thunderstorm asthma explained. Professor Christine McDonald

National study offers hope for breathlessnessNATIONAL STUDY OFFERS HOPE FOR BREATHLESSNESS

A national medication study is aiming to help thousands of Australians who struggle every day with shortness of breath

Helping Victorians breathe and sleep easy - A New Centre of Excellence in Respiratory and Sleep MedicineHELPING VICTORIANS BREATHE AND SLEEP EASY - A NEW CENTRE OF EXCELLENCE IN RESPIRATORY AND SLEEP MEDICINE

With your support we will build a life-changing Centre of Excellence in Respiratory and Sleep Medicine, improving quality of life and health outcomes for Victorians who struggle to breathe and sleep

Institute for Breathing and Sleep

Bowen Centre, Austin Hospital
145 Studley Road
Heidelberg, Victoria, 3084

(03) 9496 5390

Email Us