Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada.
Br J Anaesth. 2022 Jul;129(1):41-48. doi: 10.1016/j.bja.2022.04.006. Epub 2022 May 17.
Frailty is a state of vulnerability as a result of decreased reserves. Prehabilitation may increase reserve and improve postoperative outcomes. Our objective was to determine if home-based prehabilitation improves postoperative functional recovery in older adults with frailty having cancer surgery.
This double blind randomised trial enrolled people ≥60 yr having elective cancer surgery and ≥3 weeks from enrolment to surgery as eligible. Participation in a remotely supported, home-based exercise prehabilitation program plus nutritional guidance was compared with standard care plus written advice on age-appropriate activity and nutrition. The primary outcome was 6-min walk test (6MWT) distance at the first postoperative clinic visit. Secondary outcomes included physical performance, quality of life, disability, length of stay, non-home discharge, and 30-day readmission.
Of 543 patients assessed, 254 were eligible and 204 (80%) were randomised (102 per arm); 182 (94 intervention and 88 control) had surgery and were analysed. Mean age was 74 yr and 57% were female. Mean duration of participation was 5 weeks, mean adherence was 61% (range 0%-100%). We found no significant difference in 6MWT at follow-up (+14 m, 95% confidence interval -26-55 m, P=0.486), or for secondary outcomes. Analyses using a prespecified adherence definition of ≥80% supported improvements in 6MWT distance, complication count, and disability.
A home-based prehabilitation program did not significantly improve postoperative recovery or other outcomes in older adults with frailty having cancer surgery. Program adherence may be a key mediator of prehabilitation efficacy.
NCT02934230.
衰弱是储备减少导致的脆弱状态。预康复可以增加储备并改善术后结果。我们的目的是确定基于家庭的预康复是否可以改善患有癌症手术的衰弱老年人的术后功能恢复。
这项双盲随机试验招募了年龄≥60 岁、有选择性癌症手术且从入组到手术有≥3 周时间的患者。与标准护理加关于适合年龄的活动和营养的书面建议相比，参与远程支持的基于家庭的锻炼预康复计划加营养指导的患者。主要结局是首次术后就诊时的 6 分钟步行测试（6MWT）距离。次要结局包括身体表现、生活质量、残疾、住院时间、非家庭出院和 30 天再入院。
在评估的 543 名患者中，有 254 名符合条件，有 204 名（80%）被随机分组（每组 102 名）；182 名（94 名干预组和 88 名对照组）接受了手术并进行了分析。平均年龄为 74 岁，57%为女性。平均参与时间为 5 周，平均依从率为 61%（范围 0%-100%）。我们在随访时未发现 6MWT 有显著差异（增加 14 米，95%置信区间 -26-55 米，P=0.486），或其他次要结局。使用≥80%的预先规定的依从性定义进行的分析支持 6MWT 距离、并发症计数和残疾的改善。
基于家庭的预康复计划并未显著改善患有癌症手术的衰弱老年人的术后恢复或其他结局。计划的依从性可能是预康复疗效的关键介导因素。
NCT02934230。
