<b>Effect of Postoperative Physiotherapy and Sternal Closure Techniques on Functional Recovery Following Cardiac Surgery: A Comparative Cohort Study</b>

Recovery following cardiac surgery is influenced by multiple perioperative factors including surgical technique and postoperative rehabilitation. While conventional wire cerclage remains the most commonly used sternal closure method, alternative fixation techniques such as rigid plate fixation and plate–screw systems may provide improved sternal stability and facilitate earlier mobilization. Structured postoperative physiotherapy programs have also demonstrated significant benefits in improving functional recovery and reducing postoperative complications.This study aimed to evaluate the combined effect of postoperative physiotherapy and different sternal closure techniques on recovery outcomes in patients undergoing cardiac surgery.A comparative cohort study was conducted involving 240 patients undergoing cardiac surgery via median sternotomy. Patients were categorized according to the sternal closure technique used: wire cerclage (WC), rigid plate fixation (RPF), and plate–screw technique (PST). Each group included 80 patients, further divided into standard care (SC) and postoperative physiotherapy (PT) subgroups.Primary outcomes included hospital length of stay (LOS) ,Functional capacity measured by the six-minute walk test (6MWT) ,Health-related quality of life (SF-36) ,Postoperative pain scores (Numeric Rating Scale) and Postoperative complication rate Statistical analysis included ANOVA, chi-square testing, and multivariate regression modeling to determine independent and interaction effects.Baseline demographic characteristics were comparable across all groups (p > 0.05). Patients receiving postoperative physiotherapy demonstrated significant improvements in recovery outcomes compared with standard care.Key findings included reduction in hospital stay by 1.6–2.0 days ,Improvement in 6MWT distance by approximately 50–60 meters ,increase in SF-36 scores by 9–12 points ,significant reduction in postoperative pain scores and decrease in complication rates from 15% (WC_SC) to 4% (PST_PT) Regression analysis showed physiotherapy independently improved functional capacity (β = +48.2 m, p < 0.001). Closure technique also contributed significantly, with the plate–screw technique demonstrating the greatest improvement (β = +71 m). A significant interaction effect between physiotherapy and closure technique was observed (β = +25.4 m, p = 0.01). The model explained 62% of variance (R² = 0.62) in postoperative functional recovery. Structured postoperative physiotherapy significantly enhances recovery following cardiac surgery. Advanced sternal fixation techniques further improve patient outcomes by providing increased mechanical stability and enabling earlier mobilization. The combination of effective rehabilitation strategies and stable sternal closure techniques results in optimal postoperative recovery.