The effects of prehabilitation versus usual care to reduce postoperative complications in high-risk patients with colorectal cancer or dysplasia scheduled for elective colorectal resection: study protocol of a randomized controlled trial.
Background: Of all older patients that opt for elective colorectal surgery, approximately one-third has one or more postoperative complications, particularly those patients with a low cardiorespiratory fitness (ventilatory anaerobic threshold (VAT) < 11 mL/kg/min). A physical exercise training progr...
| Published in: | BMC Gastroenterology Vol. 18; pp. 1 - 15 |
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| Main Authors: | , , , , , , , , , , , , , |
| Format: | research randomized controlled trial Journal Article |
| Published: |
BioMed Central
2/21/2018
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128156994&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 128156994 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 1471230X 1CHO jtl: BMC Gastroenterology issn: 1471230X maglogo: N pubinfo: dt: 2/21/2018 vid: 18 pid: 24147 pub: BioMed Central artinfo: ui: 128156994 128156994 NLM29466955 128156994 10.1186/s12876-018-0754-6 NLM29466955 128156994 ppf: 1 ppct: 14 formats: tig: atl: The effects of prehabilitation versus usual care to reduce postoperative complications in high-risk patients with colorectal cancer or dysplasia scheduled for elective colorectal resection: study protocol of a randomized controlled trial. aug: au: Berkel, Annefleur E. M. Bongers, Bart C. van Kamp, Marie-Janne S. Kotte, Hayke Weltevreden, Paul de Jongh, Frans H. C. Eijsvogel, Michiel M. M. Machteld Wymenga, A. N. Bigirwamungu-Bargeman, Marloes van der Palen, Job van Det, Marc J. van Meeteren, Nico L. U. Klaase, Joost M. Wymenga, A N Machteld affil: Department of Surgery, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands sug: subj: Colorectal Neoplasms Surgery Surgery, Elective Adverse Effects Therapeutic Exercise Methods Preoperative Care Methods Postoperative Complications Prevention and Control Geriatric Assessment Symptoms Risk Assessment Aged Cost Benefit Analysis Preoperative Care Economics Human Nutritional Status Anaerobic Threshold Muscle Strength Therapeutic Exercise Economics Colorectal Neoplasms Pathology Middle Age Prospective Studies Validation Studies Comparative Studies Evaluation Research Multicenter Studies Randomized Controlled Trials Scales Aged: 65+ years Middle Aged: 45-64 years ab: Background: Of all older patients that opt for elective colorectal surgery, approximately one-third has one or more postoperative complications, particularly those patients with a low cardiorespiratory fitness (ventilatory anaerobic threshold (VAT) < 11 mL/kg/min). A physical exercise training program prior to surgery (prehabilitation) can improve their cardiorespiratory fitness. It remains to be seen whether prehabilitation also reduces postoperative complications, as most of the studies so far were rather underpowered, heterogeneous, and biased toward selection of patients with a lower risk of postoperative complications. The primary objective of this study is to evaluate the effects of a three-week prehabilitation program on 30-day postoperative complications in patients with a VAT < 11 mL/kg/min planned for elective colorectal resection for colorectal cancer or dysplasia. Methods: In this multicenter prospective randomized controlled trial, patients ≥ 60 years with colorectal cancer or dysplasia grade I, II, or III, planned for elective colorectal resection in two hospitals in the Netherlands, will be recruited. Eligible patients must have a score ≤ 7 metabolic equivalents on the veterans-specific activity questionnaire, and should be able to perform a cardiopulmonary exercise test. A total of 86 patients will be randomized (block-stratified randomization) to prehabilitation (intervention group) or usual care (control group). For final inclusion, VAT should be < 11 mL/kg/min. Three times a week for 3 weeks, a 60-min supervised prehabilitation session will be completed in community physical therapy practices by the 43 patients in the prehabilitation group, consisting of moderate-to-high intensity interval training to improve cardiorespiratory fitness, and resistance training to improve peripheral muscle strength. Additionally, patients perform home exercises twice a week on a moderate intensity level. The 43 patients in the usual care group will receive usual care. Discussion: Optimizing preoperative physical fitness may decrease the postoperative complication rate, may lead to fewer reoperations, less intense clinical care, a shorter length of stay, a more effective surgical planning (process-optimization), fewer readmissions, less intense rehabilitation, shorter rehabilitation period, earlier resumption of work, enhance patient perceived health-related quality of life, and promote performance in daily life. Cost-effectiveness should therefore be expected and evaluated. pubtype: Academic Journal doctype: research randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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