Cognitive and functional impairment are debilitating problems for survivors of major surgery. Efforts to modify medical treatments to prevent such impairment are ongoing and may yet yield significant benefits. An area in need of study is whether building patients' cognitive and physical reserve through a prescribed program of cognitive and physical exercise before the physiological insult (a prehabilitation effort) can improve long-term outcomes. Prehabilitation efforts before surgery thus far have focused on preemptive physical therapy to improve post-surgical functional outcomes. No work, however, has been done to attenuate the cognitive decline commonly seen after surgical illness by exercising the brain before the surgical insult. Cognitive prehabilitation is a novel therapeutic approach that applies well-understood techniques derived from brain plasticity research. Our approach is bolstered by data that demonstrate that cognitive training programs are effective and have a very high likelihood of fostering improvement in patient outcomes across a range of populations. It is not yet known if these programs can improve cognitive reserve, allowing patients' minds to better manage the acute stress of surgery and hospitalization. The primary aim of this pilot study is to evaluate the feasibility of cognitive and physical prehabilitation training in adult patients undergoing major non-cardiac surgery who are at risk for postoperative cognitive and functional decline. The secondary aim is to study the effects of cognitive and physical prehabilitation training on cognitive abilities, functional status, and quality of life after surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
32
Participants engage in cognitive and physical training daily for approximately 2-4 weeks prior to surgery.
Participants will be provided with personal health educational materials and access to the control version of cognitive training program.
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Participation log and diary
Proportion of eligible days that patients performed the cognitive and physical prehabilitation program, duration of time per day patients spent on each program
Time frame: From date of randomization to surgery, approximately 4 weeks
Cognitive assessment
NIH toolbox cognitive battery
Time frame: Approximately 1 month after surgery at the post-surgical clinic follow-up
Instrumental activities of daily living
FAQ questionnaire
Time frame: Approximately 1 month after surgery at the post-surgical clinic follow-up
Activities of daily living
ADL questionnaire
Time frame: Approximately 1 month after surgery at the post-surgical clinic follow-up
Functional exercise capacity
2 min walk test
Time frame: Approximately 1 month after surgery at the post-surgical clinic follow-up
Muscle strength
Hand grip strength
Time frame: Approximately 1 month after surgery at the post-surgical clinic follow-up
Pulmonary function
Incentive spirometry
Time frame: Approximately 1 month after surgery at the post-surgical clinic follow-up
Acute brain dysfunction
Delirium
Time frame: During hospital stay after surgery, for up to 2 weeks
Discharge location
Determination of location where patient was discharged from hospital to, including home, nursing facility, rehab
Time frame: From time of surgery until time of discharge or death, whichever came first, assessed up to 30 days
Pain levels
CPOT
Time frame: During hospital stay, for up to 2 weeks, and approximately 1 month after surgery at the post-surgical clinic follow-up
Pain levels
NRS
Time frame: During hospital stay, for up to 2 weeks, and approximately 1 month after surgery at the post-surgical clinic follow-up
Hospital length of stay
Duration of hospital stay
Time frame: From time of surgery until time of discharge or death, whichever came first, assessed up to 30 days
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