Home-Based Rehabilitation After Transcatheter Aortic Valve Replacement (REHAB-TAVR): A Pilot Randomized Controlled Trial

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2025-04-02 DOI:10.1111/jgs.19456

Sandra M. Shi, Faith-Anne Rapley, Heather Margulis, Roger J. Laham, Kimberly Guibone, Edward Percy, Tsuyoshi Kaneko, Kuan-Yuan Wang, Dae Hyun Kim

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引用次数: 0

Abstract

Background

The benefit of early cardiac rehabilitation after transcatheter aortic valve replacement (TAVR) is not well established. This pilot study evaluated the feasibility and short-term effects of a home-based exercise program, with or without cognitive-behavioral intervention (CBI).

Methods

We randomized 51 patients (mean age, 83.9 years; 19 women) to a home-based exercise program with CBI (Group A; n = 18) or without CBI (Group B; n = 15), or telephone-based education control (Group C; n = 18). The exercise program focusing on balance, flexibility, strength, and endurance began within 7 days post-discharge and was delivered once weekly by a physical therapist for 8 weeks. CBI included discussions on exercise benefits and barriers, goal setting, detailed exercise planning, and a weekly cash adherence incentive. The primary outcome was a disability score (range: 0–22; higher scores indicate greater disability) at 8 weeks. Secondary outcomes included the Short Physical Performance Battery (SPPB) (range: 0–12; higher scores indicate better function), self-efficacy, and outcome expectation scores. Feasibility outcomes included adherence and drop-out rates.

Results

Fifteen participants (83.3%) in Group A, 10 (58.8%) in Group B, and 10 (52.6%) in Group C completed ≥ 5 of the eight assigned weekly sessions (p = 0.196). Two participants in each group were lost to follow-up. At 8 weeks, the home-based exercise groups (Group A and B combined) demonstrated lower disability scores (mean [SE]: 2.6 [0.3] vs. 4.5 [0.5]; p = 0.042) and higher SPPB scores (9.5 [0.6] vs. 6.5 [0.8]; p = 0.003) compared with the education group (Group C). Group A had lower disability scores than Group B (2.1 [0.4] vs. 3.4 [0.5]; p = 0.047), with no differences in self-efficacy and outcome expectation scores.

Conclusions

An early, home-based, multi-domain exercise program appears feasible and may prevent disability and improve physical function in older adults after TAVR. Adding CBI, including a modest cash incentive, showed trends toward improved adherence and reduced disability.

Trial Registration: NCT02805309

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经导管主动脉瓣置换术后家庭康复（REHAB-TAVR）：一项随机对照试验。

背景：经导管主动脉瓣置换术（TAVR）后早期心脏康复的益处尚不明确。本初步研究评估了有或没有认知行为干预（CBI）的家庭锻炼计划的可行性和短期效果。方法：随机选取51例患者(平均年龄83.9岁；19名女性)加入CBI的家庭锻炼计划(a组；n = 18)或无CBI (B组；n = 15)，或基于电话的教育控制(C组；n = 18)。在出院后7天内开始进行以平衡、柔韧性、力量和耐力为重点的锻炼计划，并由物理治疗师每周进行一次，持续8周。CBI包括讨论锻炼的好处和障碍，目标设定，详细的锻炼计划，以及每周坚持现金奖励。主要结果是残疾评分(范围：0-22；分数越高表明残疾程度越严重)。次要结果包括短物理性能电池（SPPB）(范围：0-12；得分越高表明功能、自我效能和结果期望得分越好。可行性结果包括依从性和退出率。结果：A组15名参与者（83.3%），B组10名参与者（58.8%），C组10名参与者（52.6%）完成了每周8次指定疗程中的≥5次（p = 0.196）。每组两名受试者未随访。在8周时，家庭锻炼组（A组和B组合并）表现出较低的残疾评分(平均[SE]: 2.6[0.3]对4.5 [0.5]；p = 0.042)和更高的SPPB评分(9.5[0.6]比6.5 [0.8]；p = 0.003)，与教育组（C组）比较，A组残疾评分低于B组(2.1[0.4]∶3.4 [0.5]；P = 0.047)，自我效能和结果期望得分无差异。结论：早期的、以家庭为基础的、多领域的锻炼计划是可行的，可以预防老年人TAVR后的残疾和改善身体功能。加入CBI，包括适度的现金奖励，显示出提高依从性和减少残疾的趋势。试验报名：NCT02805309。

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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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.