Rehabilitation Interventions After Cardiac Surgery in Older Adults

Cardiac surgery is associated with significant postoperative physical and psychological challenges, particularly in older adults. Age-related physiological changes, combined with the effects of major surgery, often result in decreased functional capacity, delayed mobilization, increased pain levels, and heightened fear of movement (kinesiophobia). Early mobilization is a key component of postoperative recovery; however, pain and psychological barriers may limit patients' willingness and ability to participate in rehabilitation processes.

Non-pharmacological interventions that are safe, simple, and easily applicable in clinical settings may play an important role in improving recovery outcomes. Foot massage is a widely used supportive intervention that can enhance circulation, stimulate sensory receptors, promote relaxation, and reduce pain perception. Similarly, kinesio taping is a non-invasive therapeutic approach that may improve proprioception, support joint stability, enhance circulation, and reduce pain through neuromuscular mechanisms.

Despite the potential benefits of these interventions, there is limited evidence regarding their effectiveness in older adults following cardiac surgery, particularly in relation to functional performance and kinesiophobia. Moreover, studies investigating the combined relationship between pain, functional mobility, and fear of movement in this population remain scarce.

The present study is designed as a randomized controlled trial to evaluate the effects of foot massage and kinesio taping on functional performance and kinesiophobia in older adults after cardiac surgery. Participants aged 65 years and older who have undergone cardiac surgery (e.g., coronary artery bypass grafting or valve surgery) and meet the inclusion criteria will be recruited from a tertiary hospital setting.

Eligible participants will be randomly assigned to one of two intervention groups: a foot massage group or a kinesio taping group. The foot massage group will receive standardized bilateral foot massage using the Swedish massage technique for 20 minutes daily over a 7-day postoperative period. The kinesio taping group will receive kinesio taping applications applied to the foot and ankle region according to standardized procedures, with applications repeated during the same 7-day period.

Outcome measures will include functional performance assessed by the Timed Up and Go (TUG) test, kinesiophobia assessed by the Tampa Scale for Kinesiophobia (TSK), pain intensity assessed by the Visual Analog Scale (VAS), cognitive status assessed by the Standardized Mini-Mental Test (SMMT), and delirium status assessed by the Nursing Delirium Screening Scale (Nu-DESC). Assessments will be conducted preoperatively and on the seventh postoperative day.

The primary objective of this study is to compare the effects of foot massage and kinesio taping on functional performance. Secondary objectives include evaluating their effects on kinesiophobia, pain, cognitive status, and delirium. It is hypothesized that both interventions will improve functional outcomes, with kinesio taping having a greater effect on reducing kinesiophobia and foot massage having a stronger effect on pain reduction.

The findings of this study are expected to contribute to the development of effective, low-cost, and easily implementable rehabilitation strategies that support early mobilization and improve postoperative recovery in older adults undergoing cardiac surgery.

• Foot Massage (Other): A standardized Swedish massage technique will be applied to the plantar surface of both feet. The intervention will include stroking and kneading techniques applied from the metatarsal heads to the heel and toes. Each session will last 20 minutes (10 minutes per foot) and will be performed daily for 7 consecutive days by a trained healthcare professional.
• Kinesio Taping (Other): Kinesio tape (5 cm width) will be applied to the foot and ankle region using standardized techniques. One strip will be applied around the ankle, and two strips will be applied to support the medial and lateral longitudinal arches of the foot. The tape will be applied with 25-75% tension and will be administered by a certified physiotherapist. Applications will be performed twice during a 7-day postoperative period and monitored regularly.

Primary outcomes

• Timed Up and Go (TUG) Test [Preoperative baseline and postoperative day 7]: Functional mobility will be assessed using the Timed Up and Go (TUG) test. The time (in seconds) required for the participant to stand up from a seated position, walk 3 meters, turn around, walk back, and sit down will be recorded. Lower scores indicate better functional performance.

Secondary outcomes

• Kinesiophobia [Preoperative baseline and postoperative day 7]: Kinesiophobia will be assessed using the Tampa Scale for Kinesiophobia (TSK). The scale consists of 17 items scored between 17 and 68, with higher scores indicating greater fear of movement.
• Pain Intensity [Preoperative baseline and postoperative day 7]: Pain intensity will be evaluated using the Visual Analog Scale (VAS), where participants rate their pain on a scale from 0 (no pain) to 10 (worst imaginable pain).
• Cognitive Function [Preoperative baseline and postoperative day 7]: Cognitive status will be assessed using the Standardized Mini-Mental Test (SMMT), which evaluates orientation, memory, attention, and language functions. Scores range from 0 to 30, with higher scores indicating better cognitive function.
• Delirium Status [Preoperative baseline and postoperative day 7]: Delirium will be assessed using the Nursing Delirium Screening Scale (Nu-DESC), a 5-item observational tool with scores ranging from 0 to 10. Higher scores indicate increased likelihood of delirium.

Sex: All, ages: 65 Years to any

Inclusion Criteria:

* Age ≥65 years
* Undergoing cardiac surgery (e.g., coronary artery bypass grafting or valve surgery)
* Conscious and able to cooperate
* Able to provide informed consent

Exclusion Criteria:

* Presence of neurological disorders (e.g., stroke, Parkinson's disease)
* Lower extremity amputation or severe deformity
* Impaired skin integrity in the application area
* Contraindications to massage or kinesio taping
* Refusal to participate

• Asuman SALTAN, Study director, University of Yalova