Singapore's population is ageing, and more elderly people are undergoing elective major surgeries. Frail elderly experience greater functional decline and slower recovery in physical function after surgery compared to non-frail elderly. Preoperative prehabilitation aims to enhance both aerobic capacity and physical strength of elderly to attenuate the post-operative decline in physical function. Singapore General Hospital has a bespoke preoperative program - Prehabilitation for Elderly Frail Patients Undergoing Elective Surgeries (PREPARE), where patients receive physiotherapy education and instructions for home-based unsupervised exercise program (uSEP). A hospital-based supervised exercise program had also been established but the take-up rate was low (7.6%) due to barriers such as cost and accessibility. Perioperative supervised exercise training can effect greater gains in functional capacity and muscle strength compared to no supervision. For the elderly with limited transport options to the hospital, home-based supervised programmes may be more convenient compared to hospital-based supervised programmes, but the former is costlier too. Home-interventions may also empower patients with the skills and confidence to maintain their physical fitness at home, which increases their likelihood of exercising after surgery. The investigators propose a prospective single-center randomized controlled trial to evaluate the efficacy of preoperative prehabilitation with a home-based supervised exercise program (SEP) for frail elderly patients undergoing major abdominal surgery, compared to the mainstay of clinical practice, which is a home-based uSEP.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
140
Combination of aerobic and strength training exercises, in addition to home exercise instructions issued during preoperative physiotherapy education.
Eileen Yilin Sim
Singapore, Singapore
RECRUITINGChange in functional walking capacity from baseline to just before surgery, as measured using the 6-minute walk distance.
Distance that the patient can walk in 6 min, along a 15-20m hallway, at a pace that the participants will be tired at the end of the distance. This is a sub-maximal exercise test used to assess aerobic capacity and endurance. The distance covered over a time of 6 minutes is used as the outcome by which to compare changes in performance capacity.
Time frame: From recruitment to 2-days before surgery
30-day in-hospital complications
Classified using the Clavien Dindo Classification
Time frame: From day of surgery to 30-days afterwards
Hospital length-of-stay
Duration that patient stayed in hospital from day of surgery to discharge either to home or step-down care
Time frame: From day of surgery until discharge, or up to 6 months after surgery, whichever occurs first
Health-related quality of life outcomes (HRQoL) as measured using the 12-Item Short Form Survey (SF-12)
SF-12 is a 12-item questionnaire that assesses generic health outcomes from the patient's perspective, and covers eight domains: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional \& mental health.
Time frame: Day of recruitment, 2 days before surgery, 4 weeks, 8 weeks and 6 months postoperative
Health-related quality of life outcomes (HRQoL) as measured using the EQ-5D-3L
The EQ-5D-3L descriptive system comprises the following five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems, some problems, and extreme problems.
Time frame: Day of recruitment, 2 days before surgery, 4 weeks, 8 weeks and 6 months postoperative
Change in 6-minute walking distance
Distance that the patient can walk in 6 min, along a 15-20m hallway, at a pace that the participants will be tired at the end of the distance. This is a sub-maximal exercise test used to assess aerobic capacity and endurance. The distance covered over a time of 6 minutes is used as the outcome by which to compare changes in performance capacity.
Time frame: Day of recruitment, 2 days before surgery, 4 weeks and 8 weeks postoperative
Maximal Inspiratory Pressure (MIP)
The maximal inspiratory pressure reflects the strength of inspiratory muscles.
Time frame: Day of recruitment, 2 days before surgery, 4 weeks and 8 weeks postoperative
30-second and 1-minute Sit-to-Stands (STS)
The Sit to Stand test reflects lower-extremity strength and endurance.
Time frame: Day of recruitment, 2 days before surgery, 4 weeks and 8 weeks postoperative
Handgrip strength (HGS)
The handgrip strength is a measure of muscular strength or the maximum force/tension generated by one's forearm muscles. It reflects upper body strength and overall strength.
Time frame: Day of recruitment, 2 days before surgery, 4 weeks and 8 weeks postoperative
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