Prehabilitation in patients awaiting acute inpatient cardiac surgery: a pilot Study

Sarah Raut, Aaron Hales, Maureen Twiddy, Lili Dixon, Dumbor Ngaage, David Yates, Gerard Danjoux, Lee Ingle
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Abstract

Background: The concept of “prehabilitation,” or optimising individual physical and mental wellbeing prior to surgery is well established in cancer and orthopaedic populations. However, amongst the cardiac surgery population, the concept is relatively new. Of the few studies available, all focus on the elective surgical population. This pilot feasibility trial is novel as it will focus on the impact of multimodal prehabilitation on the acute inpatient cardiac surgical population. Methods: This single centre, prospective, single arm pilot feasibility trial will recruit 20 inpatients awaiting cardiac surgery. Measurements will be collected at the start of the trial (baseline), 7 days after intervention, and 14 days after the intervention or before the day of surgery. The primary outcome measure will be feasibility and practicality of the programme in an acute inpatient population. We will be looking into participant eligibility, acceptability, recruitment rates, completion rates and barriers to implementing a prehabilitation programme. Secondary outcomes include incidence of study-related adverse events, improvement in 6 minutes walk test (6MWT), hand grip strength, quality of life, anxiety scores and spirometry. At the end of the trial, we will be seeking the feedback of the participants on key components of the programme to help us inform future work. We hypothesise that light to moderate structured exercise training is low risk and feasible in patients awaiting inpatient cardiac surgery. The study was approved by Health Research Authority and Heath and Care Research Wales (Yorkshire & the Humber- Bradford Leeds Research Ethics Committee: REC reference 23/YH/0255) on the 8th November 2023. Discussion: Multimodal prehabilitation could improve individual physical and mental wellbeing whilst awaiting inpatient cardiac surgery. Prehabilitation can provide individuals with a sense of ownership and control over their condition, improve their motivation and independence, and enhance their mental and physical recovery after surgery. Traditionally, patients waiting for cardiac surgery are discouraged from physical activity/ structured exercise training and receive limited information regarding their health. Appropriate physical and psychological support could improve their confidence to mobilise sooner after surgery. This may then facilitate earlier discharge leading to improved hospital bed utilisation and patient flow.
急性住院心脏手术候诊患者的预康复:试点研究
背景:术前康复 "或 "术前优化个人身心健康 "的概念已在癌症和骨科人群中得到广泛认可。然而,在心脏外科人群中,这一概念相对较新。在为数不多的研究中,所有研究都集中在择期手术人群中。这项试点可行性试验的新颖之处在于,它将重点研究多模式术前康复对急性住院心脏手术人群的影响。方法:这项单中心、前瞻性、单臂试点可行性试验将招募 20 名等待心脏手术的住院患者。将在试验开始时(基线)、干预后 7 天、干预后 14 天或手术日之前进行测量。主要结果指标是该计划在急诊住院病人中的可行性和实用性。我们将调查参与者的资格、接受度、招募率、完成率以及实施康复前计划的障碍。次要结果包括与研究相关的不良事件发生率、6 分钟步行测试 (6MWT) 改善情况、手部握力、生活质量、焦虑评分和肺活量。试验结束后,我们将征求参与者对该计划关键部分的反馈意见,以帮助我们为今后的工作提供参考。我们假设,对于等待心脏手术的住院病人来说,轻度至中度的结构化运动训练风险低且可行。该研究获得了健康研究管理局和威尔士健康与护理研究(约克郡和坎普;亨伯-布拉德福德-利兹)研究伦理委员会的批准:REC编号23/YH/0255)于2023年11月8日批准。讨论在等待心脏手术住院期间,多模式预康复可改善个人的身心健康。术前康复可让患者对自己的病情有一种主人翁感和控制感,提高他们的积极性和独立性,促进术后身心康复。传统上,等待心脏手术的病人不愿意参加体育锻炼/有组织的运动训练,他们获得的有关自身健康的信息也很有限。适当的身体和心理支持可以增强他们的信心,让他们在术后更快地行动起来。这将有助于患者尽早出院,从而提高医院床位利用率,改善患者流量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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