Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
Medical Unit Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden.
BMC Cancer. 2024 Oct 24;24(1):1306. doi: 10.1186/s12885-024-13059-y.
Physical activity is thought to be a key component in reducing postoperative complications following major abdominal surgery. The available literature on exercise interventions following radical cystectomy in patients with bladder cancer is scarce but suggests that physical activity and exercise might improve physical function and health-related quality of life, thus calling for further investigation. The CanMoRe-trial is a single-blinded randomised controlled trial (Clinicals Trials NCT03998579 25/06/2019), aimed at evaluating the impact of an exercise intervention in primary care following robot-assisted radical cystectomy. This study seeks to explore patients' experiences of the exercise intervention in the CanMoRe-trial to gain a better understanding of facilitating aspects and potential barriers.
A qualitative study was conducted involving 20 patients from the intervention group of the CanMoRe-trial who were interviewed individually between October 2020 and March 2023 using a semi-structured interview guide. The interviews were recorded and transcribed verbatim and reflexive thematic analysis was used to analyse the data.
Four main themes were identified: Having to adapt to new circumstances, describing the challenges regarding physical activity patients face after discharge. Optimising conditions for rehabilitation, describing how practical conditions affect patients' ability to exercise. Motivated to get back to normal, describing patients´ desire to get back to normal life and factors influencing motivation. Importance of a supportive environment, describing the impact of social support, support from physiotherapists, and how the environment where exercise takes place impacts patients' ability to exercise.
This study found that patients participating in the CanMoRe-trial are positive towards physical exercise in PC following radical RARC. They are motivated to get back to normal life but face major challenges when arriving home following surgery, which affect their ability to perform physical activity and engage in exercise. Conditions need to be optimised to support patients' ability to engage in exercise by providing an accessible PC location to perform exercise in. A supportive environment is also needed, including guidance from healthcare professionals regarding which type of exercise, intensity and amount of exercise that should be performed, enabling patients gradually to develop self-efficacy regarding exercise and focusing on goals related to patients' normal lives before surgery.
体力活动被认为是减少腹部大手术后术后并发症的关键组成部分。关于膀胱癌患者根治性膀胱切除术后运动干预的现有文献很少，但表明体力活动和锻炼可能会改善身体功能和健康相关生活质量，因此需要进一步研究。CanMoRe 试验是一项单盲随机对照试验（Clinicals Trials NCT03998579 25/06/2019），旨在评估初级保健中机器人辅助根治性膀胱切除术后运动干预的影响。本研究旨在探讨 CanMoRe 试验中干预组患者对运动干预的体验，以更好地了解促进因素和潜在障碍。
一项定性研究涉及 CanMoRe 试验干预组的 20 名患者，他们于 2020 年 10 月至 2023 年 3 月期间使用半结构化访谈指南进行了单独访谈。访谈进行了录音并逐字记录，并使用反思性主题分析对数据进行了分析。
确定了四个主要主题：适应新环境，描述患者出院后面临的体力活动挑战。优化康复条件，描述实际条件如何影响患者的运动能力。渴望恢复正常，描述患者恢复正常生活的愿望以及影响动机的因素。支持性环境的重要性，描述社会支持、物理治疗师支持的影响以及运动发生的环境如何影响患者的运动能力。
本研究发现，参加 CanMoRe 试验的患者对根治性 RARC 后 PC 中的体育锻炼持积极态度。他们渴望恢复正常生活，但手术后回家时面临重大挑战，这影响了他们进行体力活动和参与运动的能力。需要优化条件，为患者提供可访问的 PC 位置进行运动，以支持他们进行运动的能力。还需要一个支持性的环境，包括医疗保健专业人员提供的关于应进行哪种运动、运动强度和运动量的指导，使患者逐渐对运动建立自我效能感，并专注于手术前与患者正常生活相关的目标。
