Franssen Ruud F W, Bongers Bart C, Vogelaar F Jeroen, Janssen-Heijnen Maryska L G
Department of Clinical Physical Therapy, VieCuri Medical Center, Tegelseweg 210 5912BL, Venlo, the Netherlands.
Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Perioper Med (Lond). 2022 Jul 26;11(1):28. doi: 10.1186/s13741-022-00260-5.
Prehabilitation appears to be an effective strategy to reduce postoperative complications and enhance recovery after colorectal surgery. Although many patients prefer (unsupervised) home-based prehabilitation, adherence can be problematic. Combining home-based prehabilitation with tele-monitoring might demonstrate a higher adherence than unsupervised prehabilitation; however, evidence on its feasibility and effectiveness in patients with colorectal cancer scheduled for elective surgery who are at high risk for postoperative complications is lacking. The aim of this study was to assess the feasibility of a bimodal tele-prehabilitation program in patients with colorectal cancer at high risk for postoperative complications.
High-risk patients (oxygen uptake at the ventilatory anaerobic threshold ≤11 mL/kg/min or oxygen uptake at peak exercise ≤ 18 mL/kg/min) with colorectal cancer were included in a home-based bimodal tele-prehabilitation program. The program consisted of a personalized tele-monitored moderate to high-intensity interval training intervention and nutritional counseling. Feasibility was measured by participation rate, dropout rate, adherence to the physical exercise training session's frequency, intensity, and time, and retention rate. Patient appreciation was measured by a patient appreciation questionnaire. Changes in preoperative physical fitness as secondary outcomes were quantified by time to exhaustion on a constant work rate (cycle) test, number of repetitions on the 30-s chair-stand test, and walking speed on the 4-m gait speed test.
The participation rate was 81%, there were no adverse events, and all participants managed to complete the tele-prehabilitation program (retention rate of 100%). Adherence with regard to the exercise program's frequency, intensity, and time was respectively 91%, 84%, and 100%. All participants appreciated the tele-prehabilitation program. Time to exhaustion on the constant work rate test improved (not statistically significant) from a pre-prehabilitation median score of 317 seconds to a post-prehabilitation median score of 412 seconds (p = 0.24). Median number of repetitions on the 30-s chair-stand test improved from 12 to 16 (p = 0.01).
Tele-prehabilitation seems feasible in high-risk patients with colorectal cancer, but efforts should be made to further improve adherence to physical exercise training intensity. More research is needed to establish the (cost-)effectiveness of tele-prehabilitation regarding preoperative improvements in preoperative aerobic fitness and postoperative reduction of complications.
ISRCTN, ISRCTN64482109 . Registered 09 November 2021 - Retrospectively registered.
术前康复似乎是降低结直肠手术后并发症并促进恢复的有效策略。尽管许多患者更喜欢（无监督的）居家术前康复，但依从性可能存在问题。将居家术前康复与远程监测相结合可能比无监督的术前康复具有更高的依从性；然而，对于计划接受择期手术且术后并发症风险高的结直肠癌患者，其可行性和有效性的证据尚缺乏。本研究的目的是评估一种双模式远程术前康复计划在术后并发症高风险的结直肠癌患者中的可行性。
将结直肠癌高风险患者（通气无氧阈时摄氧量≤11 mL/kg/min或运动峰值时摄氧量≤18 mL/kg/min）纳入居家双模式远程术前康复计划。该计划包括个性化远程监测的中等到高强度间歇训练干预和营养咨询。通过参与率、退出率、对体育锻炼训练课程频率、强度和时间的依从性以及保留率来衡量可行性。通过患者满意度问卷来衡量患者满意度。作为次要结局的术前体能变化通过恒定工作率（自行车）测试中的疲劳时间、30秒椅子站立测试中的重复次数以及4米步态速度测试中的步行速度来量化。
参与率为81%，无不良事件发生，所有参与者均成功完成远程术前康复计划（保留率为100%）。锻炼计划在频率、强度和时间方面的依从性分别为91%、84%和100%。所有参与者都对远程术前康复计划表示满意。恒定工作率测试中的疲劳时间从术前康复前的中位数317秒改善（无统计学意义）至术前康复后的中位数412秒（p = 0.24）。30秒椅子站立测试中的重复次数中位数从12次提高到16次（p = 0.01）。
远程术前康复在术后并发症高风险的结直肠癌患者中似乎可行，但应努力进一步提高对体育锻炼训练强度的依从性。需要更多研究来确定远程术前康复在术前有氧适能改善和术后并发症减少方面的（成本 -）效益。
ISRCTN，ISRCTN64482109。2021年11月9日注册 - 追溯注册。
