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Steffens D, Young J, Beckenkamp PR, Ratcliffe J, Rubie F, Ansari N, Pillinger N, Koh C, Munoz PA, Solomon M. Feasibility and acceptability of a preoperative exercise program for patients undergoing major cancer surgery: results from a pilot randomized controlled trial. Pilot Feasibility Stud 2021; 7:27. [PMID: 33441181 PMCID: PMC7805142 DOI: 10.1186/s40814-021-00765-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 01/03/2021] [Indexed: 12/11/2022] Open
Abstract
Objective To establish the feasibility and acceptability of a preoperative exercise program, and to obtain pilot data on the likely difference in key surgical outcomes to inform the sample size calculation for a full-scale trial. Design Pilot randomized controlled trial. Setting Royal Prince Alfred Hospital, Sydney, Australia. Subjects We included patients undergoing elective pelvic exenteration or cytoreductive surgery aged 18 to 80 years, who presented to the participating gastrointestinal surgeon at least 2 weeks prior to surgery. Patients presenting cognitive impairment, co-morbidity preventing participation in exercise, inadequate English language, currently participating in an exercise program or unable to attend the exercise program sessions were excluded. Methods Participants were randomized to a 2–6 weeks preoperative, face-to-face, individualised exercise program or to usual care. Feasibility was assessed with consent rates to the study, and for the intervention group, retention and adherence rates to the preoperative exercise program. Acceptability of the exercise program was assessed with a semi-structured questionnaire exploring the advice received and the amount, duration and intensity of the exercise program. In addition, postoperative complication rates (Clavien-Dindo), length of hospital stay and self-reported measures of health-related quality of life (SF-36v2) were collected at baseline, day before surgery and in-hospital up to discharge from hospital. Results Of 122 patients screened, 26 (21%) were eligible and 22 (85%) accepted to participate in the trial and were randomized to the intervention (11; 50%) or control group (11; 50%). The median age of the include participants was 63 years. Adherence to the preoperative exercise sessions was 92.7%, with all participants either satisfied (33%) or extremely satisfied (67%) with the overall design of the preoperative exercise program. No significant differences in outcomes were found between groups. Conclusions The results of our pilot trial demonstrate that a preoperative exercise program is feasible and acceptable to patients undergoing major abdominal cancer surgery. There is an urgent need for a definite trial investigating the effectiveness of a preoperative exercise program on postoperative outcomes in patients undergoing major abdominal cancer surgery. This could potentially reduce postoperative complication rates, length of hospital stay and subsequently overall health care costs. Trial registration ACTRN12617001129370. Registered on August 1, 2017, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373396&showOriginal=true&isReview=true Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00765-8.
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Affiliation(s)
- Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, Camperdown, New South Wales, 2050, Australia. .,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Building 89, Leval 9, Missenden Road, Camperdown, New South Wales, 2006, Australia.
| | - Jane Young
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, Camperdown, New South Wales, 2050, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Building 89, Leval 9, Missenden Road, Camperdown, New South Wales, 2006, Australia.,Institiute of Academic Surgery (IAS), Royal Prince Alfred Hospital, 145-147 Missenden Road, Camperdown, New South Wales, 2050, Australia
| | - Paula R Beckenkamp
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Lidcombe, New South Wales, 2141, Australia
| | - James Ratcliffe
- Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2006, Australia
| | - Freya Rubie
- Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2006, Australia
| | - Nabila Ansari
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, Camperdown, New South Wales, 2050, Australia
| | - Neil Pillinger
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Building 89, Leval 9, Missenden Road, Camperdown, New South Wales, 2006, Australia.,Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2006, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, Camperdown, New South Wales, 2050, Australia
| | - Phillip A Munoz
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Lidcombe, New South Wales, 2141, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2006, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, Camperdown, New South Wales, 2050, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Building 89, Leval 9, Missenden Road, Camperdown, New South Wales, 2006, Australia.,Institiute of Academic Surgery (IAS), Royal Prince Alfred Hospital, 145-147 Missenden Road, Camperdown, New South Wales, 2050, Australia
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Steffens D, Young J, Beckenkamp PR, Ratcliffe J, Rubie F, Ansari N, Pillinger N, Solomon M. Feasibility and acceptability of PrE-operative Physical Activity to improve patient outcomes After major cancer surgery: study protocol for a pilot randomised controlled trial (PEPA Trial). Trials 2018; 19:112. [PMID: 29452599 PMCID: PMC5816517 DOI: 10.1186/s13063-018-2481-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 01/18/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is a need for evidence of the effectiveness of pre-operative exercise for patients undergoing major cancer surgery; however, recruitment to such trials can be challenging. The PrE-operative Physical Activity (PEPA) Trial will establish the feasibility and acceptability of a pre-operative exercise programme aimed to improve patient outcomes after cytoreductive surgery and pelvic exenteration. The secondary aim is to obtain pilot data on the likely difference in key outcomes (post-operative complications, length of hospital stay, post-operative functional capacity and quality of life) to inform the sample size calculation for the substantive randomised clinical trial. METHODS/DESIGN Twenty patients undergoing cytoreductive surgery and pelvic exenteration at the Royal Prince Alfred Hospital, Sydney will be recruited and randomly allocated (1:1 ratio) to either 2 to 6 weeks' pre-operative exercise programme (intervention group) or usual care (control group). Those randomised to the intervention group will receive up to six individualised, 1-h physiotherapy sessions (including aerobic and endurance exercises, respiratory muscle exercises, stretching and flexibility exercises), home exercises (instruction and recommendations on how to progress the exercises at home) and encouragement to be more active by using an activity tracker to measure the number of steps walked daily. Patients allocated to the control group will not receive any specific advice about exercise training. Feasibility will be assessed with consent rates to the study, and for the intervention group, retention and adherence rates to the exercise programme. Acceptability of the exercise programme will be assessed with a semi-structured questionnaire. The following measures of the effectiveness of the intervention will be collected at baseline (2 to 6 weeks pre-operative), a week before surgery, during hospital stay and pre hospital discharge: post-operative complication rates (Clavien-Dindo), post-operative functional capacity (Six-minute Walk Test) and quality of life (SF-36v2®) and length of hospital stay. Functional status will be additionally measured using Cardiopulmonary Exercise Testing (CPET), at baseline and within a week before surgery. DISCUSSION The PEPA Trial will provide important information about the feasibility and acceptability of a pre-operative exercise programme for patients undergoing major cancer surgery. Data from the PEPA Trial will be used to inform the design, methodology and to calculate sample size required for a larger, definitive trial. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ID: ACTRN12617001129370 . Registered on 1 August 2017.
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Affiliation(s)
- Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Building 89, Level 9, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia. .,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
| | - Jane Young
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Building 89, Level 9, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Paula R Beckenkamp
- Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Sydney, NSW, Australia
| | - James Ratcliffe
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Freya Rubie
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nabila Ansari
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Building 89, Level 9, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
| | - Neil Pillinger
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Building 89, Level 9, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW, Australia
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