Prehabilitation for frail patients undergoing colorectal surgery: lessons learnt from a randomised feasibility study

Furyk, Claire, Senthuran, Siva, Nye, Dia, Ho, Yik-H., and Leicht, Anthony S. (2021) Prehabilitation for frail patients undergoing colorectal surgery: lessons learnt from a randomised feasibility study. Frontiers in Rehabilitation, 2. 650835.

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Abstract

There is substantial interest by clinicians to improve the health outcomes of older and frail patients followingmajor surgery, with prehabilitation a potential and important component of future standard patient care. We studied the feasibility of a randomised controlled trial of pre-operative prehabilitation in frail patients scheduled for colorectal surgery in regional Australia. We conducted a single blind, parallel arm, randomised controlled trial in a regional referral centre where colorectal surgical patients aged over 50 were invited to participate and screened for frailty. Frail patients were randomised to undertake either a 4-week supervised exercise program with dietary advice, or usual care. The primary outcome was 6-min-walk-distance at baseline, pre-surgery (4 weeks later) and at follow-up (4–6 weeks post-operation). Secondary outcomes included physical activity level, health-related quality of life, and post-surgical complications. Feasibility outcomes were numbers of patients reaching each stage and barriers or reasons for withdrawal. Of 106 patients eligible for screening during the 2-year study period, only five were able to be randomised, of which one alone completed the entire study to follow-up. Fewer patients than expected met the frailty criteria (23.6%), and many (22.6%) were offered surgery in a shorter timeframe than the required 4 weeks. Physical and psychological aspects of frailty and logistical issues were key for patients declining study participation and/or not complying with the intervention and/or all outcome assessments. Feasibility for a large randomised controlled trial of prehabilitation for frail colorectal patients was poor (~5%) for our regional location. Addressing barriers, examination of a large, dense population base, and utilisation of a frailty-screening tool validated in surgical patients are necessary for future studies to identify the impact of prehabilitation for frail patients.

Item ID: 71520
Item Type: Article (Research - C1)
ISSN: 2673-6961
Keywords: exercise, cancer, frailty, barriers, regional centre, quality of life
Copyright Information: Copyright © 2021 Furyk, Senthuran, Nye, Ho and Leicht. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Funders: Townsville Hospital Private Practice Research Fund, Australian and New Zealand College of Anaesthetists
Date Deposited: 03 Feb 2022 22:34
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3211 Oncology and carcinogenesis > 321104 Cancer therapy (excl. chemotherapy and radiation therapy) @ 50%
42 HEALTH SCIENCES > 4207 Sports science and exercise > 420799 Sports science and exercise not elsewhere classified @ 50%
SEO Codes: 20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 50%
20 HEALTH > 2004 Public health (excl. specific population health) > 200412 Preventive medicine @ 50%
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