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Punnoose A, Weiss O, Khanduja V, Rushton AB. Effectiveness of prehabilitation for patients undergoing orthopaedic surgery: protocol for a systematic review and meta-analysis. BMJ Open 2019; 9:e031119. [PMID: 31748299 PMCID: PMC6887053 DOI: 10.1136/bmjopen-2019-031119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 10/25/2019] [Accepted: 11/04/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Undergoing major surgery can induce physical and functional decline. Prehabilitation programmes aim to improve physical fitness and function preoperatively and could enhance postoperative recovery and outcomes. Prehabilitation interventions have been utilised across a range of orthopaedic populations of all ages and can be multimodal in nature. The aim of this study is to evaluate the effectiveness of prehabilitation for patients undergoing orthopaedic surgery including day surgery procedures. It will also investigate the components of prehabilitation to understand optimum duration and frequency of programmes. METHODS/DESIGN Systematic review and meta-analysis designed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. A comprehensive electronic search will be performed in MEDLINE, CINAHL, AMED, Embase, PEDro and Cochrane CENTRAL databases in order to identify randomised control trials published between January 2000 to 25 March 2019. ISI Web of Science, System for information on grey literature and the European Union clinical trials registry will identify studies that are underway or unpublished. Two independent reviewers will carry out the searches, study selection (title and abstract and full text stages), data extraction, risk of bias assessment (Cochrane Risk of Bias tool 2.0) and evaluation of overall strength of evidence. Meta-analyses will be used for data which demonstrates homogeneity, otherwise a narrative synthesis will be performed for groups of studies of high heterogeneity (I2 >50%). The overall strength of the body of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION This study raises no ethical issues. This study aims to identify the effectiveness of prehabilitation interventions and may assist clinicians in determining which components, duration, frequency and the method of delivery would form the most effective prehabilitation intervention for patients undergoing an orthopaedic surgical procedure. The findings will be disseminated through publication in a peer-reviewed journal and conference presentations. PROSPERO REGISTRATION NUMBER CRD42019123268.
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Affiliation(s)
- Anuj Punnoose
- Physiotherapy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Ori Weiss
- Department of Trauma and Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Vikas Khanduja
- Department of Trauma and Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Alison B Rushton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham Edgbaston campus, Birmingham, UK
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102
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Northgraves MJ, Arunachalam L, Madden LA, Marshall P, Hartley JE, MacFie J, Vince RV. Feasibility of a novel exercise prehabilitation programme in patients scheduled for elective colorectal surgery: a feasibility randomised controlled trial. Support Care Cancer 2019; 28:3197-3206. [PMID: 31712950 PMCID: PMC7256075 DOI: 10.1007/s00520-019-05098-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/20/2019] [Indexed: 12/12/2022]
Abstract
Background and objectives To investigate the feasibility of delivering a functional exercise-based prehabilitation intervention and its effects on postoperative length of hospital stay, preoperative physical functioning and health-related quality of life in elective colorectal surgery. Materials and methods In this randomised controlled feasibility trial, 22 elective colorectal surgery patients were randomly assigned to exercise prehabilitation (n = 11) or standard care (n = 11). Feasibility of delivering the intervention was assessed based on recruitment and compliance to the intervention. Impact on postoperative length of hospital stay and complications, preoperative physical functioning (timed up and go test, five times sit to stand, stair climb test, handgrip dynamometry and 6-min walk test) and health-related quality of life were also assessed. Results Over 42% of patients (84/198) screened were deemed ineligible for prehabilitation due to insufficient time existing prior to scheduled surgery. Of those who were eligible, approximately 18% consented to the trial. Median length of hospital stay was 8 [range 6–27] and 10 [range 5–12] days respectively for the standard care and prehabilitation groups. Patterns towards preoperative improvements for the timed up and go test, stair climb test and 6-min walk test were observed for all participants receiving prehabilitation but not standard care. Conclusions Despite prehabilitation appearing to convey positive benefits on physical functioning, short surgical wait times and patient engagement represent major obstacles to implementing exercise prehabilitation programmes in colorectal cancer patients. Electronic supplementary material The online version of this article (10.1007/s00520-019-05098-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthew J Northgraves
- Hull Health Trials Unit, University of Hull, Hull, UK.,Sport, Health and Exercise Science, School of Life Sciences, University of Hull, Hull, UK
| | | | - Leigh A Madden
- Department of Biomedical Science, School of Life Sciences, University of Hull, Hull, UK
| | - Philip Marshall
- Sport, Health and Exercise Science, School of Life Sciences, University of Hull, Hull, UK
| | | | - John MacFie
- Combined Gastroenterology Research Unit, Scarborough Hospital, Scarborough, UK
| | - Rebecca V Vince
- Sport, Health and Exercise Science, School of Life Sciences, University of Hull, Hull, UK.
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103
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Schram A, Ferreira V, Minnella EM, Awasthi R, Carli F, Scheede-Bergdahl C. In-hospital resistance training to encourage early mobilization for enhanced recovery programs after colorectal cancer surgery: A feasibility study. Eur J Surg Oncol 2019; 45:1592-1597. [DOI: 10.1016/j.ejso.2019.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/24/2019] [Indexed: 01/06/2023] Open
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105
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Miralpeix E, Mancebo G, Gayete S, Corcoy M, Solé-Sedeño JM. Role and impact of multimodal prehabilitation for gynecologic oncology patients in an Enhanced Recovery After Surgery (ERAS) program. Int J Gynecol Cancer 2019; 29:1235-1243. [DOI: 10.1136/ijgc-2019-000597] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/20/2022] Open
Abstract
Patients undergoing major surgery are predisposed to a decrease in functional capacity as a response to surgical stress that can delay post-operative recovery. A prehabilitation program consists of patient preparation strategies before surgery, and include pre-operative measures to improve functional capacity and enhance post-operative recovery. Multimodal prehabilitation may include exercise, nutritional counseling, psychological support, and optimization of underlying medical conditions, as well as cessation of unfavorable health behaviors such as smoking and drinking. Currently, there are no standardized guidelines for prehabilitation, and the existent studies are heterogeneous; however, multimodal approaches are likely to have a greater impact on functional outcomes than single management programs. We have reviewed the literature on prehabilitation in general, and in gynecologic surgery in particular, to identify tools to establish an optimal prehabilitation program within an Enhanced Recovery After Surgery (ERAS) protocol for gynecologic oncology patients. We suggest a safe, reproducible, functional, and easy-to-apply multimodal prehabilitation program for gynecologic oncology practice based on patient-tailored pre-operative medical optimization, physical training, nutritional counseling, and psychological support. The analysis of the prehabilitation program implementation in an ERAS protocol should undergo further research in order to test the efficacy on surgical outcome and recovery after surgery.
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106
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Reis PGDA, Polakowski C, Lopes M, Bussyguin DS, Ferreira RP, Preti VB, Tomasich FDS. Abbreviated preoperative fasting favours postoperative oral intake at lower hospital admission costs for cancer patients. Rev Col Bras Cir 2019; 46:e20192175. [PMID: 31389524 DOI: 10.1590/0100-6991e-20192175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/17/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to evaluate the feasibility of abbreviated fasting in oncologic colorectal surgeries, as well as the impact on the surgical outcome of the patients. METHODS prospective randomized comparative study with patients undergoing elective colorectal cancer surgeries from May to September 2017. Patients were randomized electronically into two groups according to the preoperative fast to be adopted: conventional or abbreviated. RESULTS of the 33 patients included, 15 followed the abbreviated fasting protocol and 18 the conventional fasting. Both groups had comparable profiles. No patient underwent mechanical preparation of the colon. In 69.7% of the cases, surgery involved low rectal dissection. The procedures were equivalent in relation to intraoperative variables and severe complications. The time to achieve complete oral intake was shorter for abbreviated fasting (10 versus 16 days, p=0.001), as well as the length of inhospital stay (2 versus 4 days, p=0.009). Hospital costs were lower in the abbreviated fasting (331 versus 682 reais, p<0.001). The univariable analysis revealed a correlation between complete oral intake and abbreviated fasting [HR 0.29 (IC95%: 0.12-0.68] and abdominal distension [HR 0.12 (IC95% 0.01-0.94)]. After multivariable analysis, abbreviated fasting presented a lower time for complete oral intake [HR 0.39 (IC95%: 0.16-0.92]. CONCLUSION the abbreviated preoperative fasting favors the metabolic-nutritional recovery, reducing the time for complete oral intake. The implementation of the abbreviation protocol reduces hospital admission costs.
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Affiliation(s)
| | - Camila Polakowski
- Hospital Erasto Gaertner, Serviço de Nutrição, Equipe Multidisciplinar de Terapia Nutricional (EMTN), Curitiba, PR, Brasil
| | - Marina Lopes
- Hospital Erasto Gaertner, Serviço de Nutrição, Equipe Multidisciplinar de Terapia Nutricional (EMTN), Curitiba, PR, Brasil
| | | | | | - Vinicius Basso Preti
- Hospital Erasto Gaertner, Serviço de Nutrição, Equipe Multidisciplinar de Terapia Nutricional (EMTN), Curitiba, PR, Brasil.,Hospital Erasto Gaertner, Serviço de Cirurgia Abdominal, Curitiba, PR, Brasil
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107
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Borrell-Vega J, Esparza Gutierrez AG, Humeidan ML. Multimodal Prehabilitation Programs for Older Surgical Patients. Anesthesiol Clin 2019; 37:437-452. [PMID: 31337477 DOI: 10.1016/j.anclin.2019.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite advances in perioperative care, short-term and long-term postoperative complications are still experienced by many patients, which is of special relevance to the older adult population, considered to be high-risk surgical candidates because of less functional reserve and comorbidity burden. Through the implementation of prehabilitation programs, patients can be optimized to handle the physical and mental stress of surgery. Benefits have been described in a variety of surgical populations, but more studies targeting older surgical patients are needed. These studies should include standardized prehabilitation protocols and large sample sizes to avoid the limitations of the existing prehabilitation literature.
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Affiliation(s)
- Jaume Borrell-Vega
- Department of Anesthesiology - Clinical Research, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, N-411 Doan Hall, Columbus, OH 43210, USA.
| | - Alan G Esparza Gutierrez
- Department of Anesthesiology - Clinical Research, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, N-411 Doan Hall, Columbus, OH 43210, USA
| | - Michelle L Humeidan
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, N-411 Doan Hall, Columbus, OH 43210, USA
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108
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Awasthi R, Minnella EM, Ferreira V, Ramanakumar AV, Scheede-Bergdahl C, Carli F. Supervised exercise training with multimodal pre-habilitation leads to earlier functional recovery following colorectal cancer resection. Acta Anaesthesiol Scand 2019; 63:461-467. [PMID: 30411316 DOI: 10.1111/aas.13292] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/18/2018] [Accepted: 10/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Exercise training is a component of the pre-habilitation program. While in one previous study the training was home-based, in a subsequent investigation it was supervised in hospital. The hypothesis of this secondary analysis of the two studies was to determine whether supervised exercise further accelerates the return to baseline walking ability. METHODS Data from two consecutive randomized control trials (RCT) comparing pre-habilitation to the rehabilitation of cancer patients scheduled for colorectal surgery were pooled for analysis. The interventions were similar and included home-based exercise training, nutritional counseling and protein supplementation, and relaxation techniques administered either before surgery (pre-habilitation) or after surgery (rehabilitation). Patients in the second RCT received additional supervised exercise sessions. Functional capacity was assessed with the 6-minute walk test (6 MWT) at baseline, before surgery, and at 4 and 8 weeks after surgery. Adjusted logistic regression was used to determine the improvement of the 6-minute walk distance (6MWD). RESULTS Baseline mean 6MWD of 63 patients in the supervised group was 465.1 m (SD, 115), and that of 77 patients in the nonsupervised group was 407.8 m (SD, 109) (P < 0.01). Perioperative supervised exercise training enhanced further functional capacity and muscle strength when compared with the nonsupervised group (P < 0.01). Those receiving exercise supervision had over two times higher chances to return to baseline after surgery. Supervised pre-habilitation was the best combination (4 weeks OR = 7.71, and at 8 weeks OR = 8.62). CONCLUSION Supervised exercise training leads to meaningful changes in functional capacity thus accelerating the postoperative return to baseline activities.
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109
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Gillis C, Wischmeyer PE. Pre-operative nutrition and the elective surgical patient: why, how and what? Anaesthesia 2019; 74 Suppl 1:27-35. [PMID: 30604414 DOI: 10.1111/anae.14506] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2018] [Indexed: 01/04/2023]
Abstract
Pre-operative nutrition therapy is increasingly recognised as an essential component of surgical care. The present review has been formatted using Simon Sinek's Golden Circle approach to explain 'why' avoiding pre-operative malnutrition and supporting protein anabolism are important goals for the elective surgical patient, 'how' peri-operative malnutrition develops leading in part to a requirement for pre-operative anabolic preparation, and 'what' can be done to avoid pre-operative malnutrition and support anabolism for optimal recovery.
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Affiliation(s)
- C Gillis
- Peri-Operative Program, McGill University, Montreal, QC, Canada
| | - P E Wischmeyer
- Director of Peri-operative Research, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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Scheede-Bergdahl C, Minnella EM, Carli F. Multi-modal prehabilitation: addressing the why, when, what, how, who and where next? Anaesthesia 2019; 74 Suppl 1:20-26. [PMID: 30604416 DOI: 10.1111/anae.14505] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 11/29/2022]
Abstract
Just as there is growing interest in enhancing recovery after surgery, prehabilitation is becoming a recognised means of preparing the patient physically for their operation and/or subsequent treatment. Exercise training is an important stimulus for improving low cardiovascular fitness and preserving lean muscle mass, which are critical factors in how well the patient recovers from surgery. Despite the usual focus on exercise, it is important to recognise the contribution of nutritional optimisation and psychological wellbeing for both the adherence and the response to the physical training stimulus. This article reviews the importance of a multi-modal approach to prehabilitation in order to maximise its impact in the pre-surgical period, as well as critical future steps in its development and integration in the healthcare system.
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Affiliation(s)
- C Scheede-Bergdahl
- Department of Anesthesia, McGill University, Montreal General Hospital, Montreal, QC, Canada.,Department of Kinesiology and Physical Education, McGill Research Centre for Physical Activity and Health, McGill University, Montreal, QC, Canada.,McGill Research Centre for Physical Activity and Health, McGill University, Montreal, QC, Canada
| | - E M Minnella
- Department of Anesthesia, McGill University, Montreal General Hospital, Montreal, QC, Canada
| | - F Carli
- Department of Anesthesia, McGill University, Montreal General Hospital, Montreal, QC, Canada
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111
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Voigt N, Cho H, Schnall R. Supervised Physical Activity and Improved Functional Capacity among Adults Living with HIV: A Systematic Review. J Assoc Nurses AIDS Care 2018; 29:667-680. [PMID: 29861318 DOI: 10.1016/j.jana.2018.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 05/04/2018] [Indexed: 12/18/2022]
Abstract
Physical activity (PA) combats the effects of multimorbidity and antiretroviral therapy in people living with HIV (PLWH), but PLWH often don't meet recommended PA guidelines. The purpose of our review was to investigate whether supervised PA improved functional capacity in PLWH. Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Five databases were searched for randomized controlled trials in English, with participants ages 18 years and older, and a supervised PA intervention. A database search yielded 8,267 articles, with 15 eligible for review inclusion. We found a low risk of bias within and across studies. Combined aerobic/progressive resistance training (PRT) improved strength, cardiovascular, and flexibility outcomes; aerobic interventions alone showed no significant improvements; PRT improved strength outcomes; yoga or yoga/meditation showed no outcome differences; and t'ai chi showed cardiovascular and flexibility improvements. We found that supervised PA increased functional capacity in PLWH and that self-report was not a reliable assessment.
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