Multidisciplinary Prehabilitation to Improve Frailty and Functional Capacity in High-risk Elective Surgical Patients: a Retrospective Pilot Study

NCT05668221 | Completed

• 1 other identifier: 2021.493-T
• Study Type: observational
• Target: 55
• Locations: 1 country
• Sites: 1

Brief Summary

Frailty is a multidimensional syndrome in which multiple small physiological deficits accumulate gradually, resulting in a loss of physiological reserve and adaptability, putting a patient that is exposed to stressor at a higher risk of adverse outcomes. Both pre-frailty and frailty are associated with worse outcomes and higher healthcare costs. With the potential "teachable" moment from the long surgical waiting time in Hong Kong, the effect of a prehabilitation program incorporated into clinical care pathway in high-risk frail patients undergoing elective major surgery were evaluated.

Conditions

Frailty Syndrome

Outcome Measures

Primary Outcomes (3)

• Recruitment rate

  Number of patients successfully enrolled into prehabilitation program divided by the number of patients attending prehabilitation clinic

  Up to 1 year after the first case recruitment

• Attrition rate

  Number of patients who dropped out divided by the number of patients enrolled into prehabilitation program

  Through study completion, an average of 18 months after the first recruitment

• Adherence of patients to prehabilitation program

  Number of patients completed prehabilitation program divided by the number of patients enrolled

  Through study completion, an average of 18 months after the first recruitment

Secondary Outcomes (9)

• 6-minute walk test distance

  1 year

• Calculated peak oxygen uptake

  1 year

• Hand grip strength

  1 year

• 30 second chair stand test

  1 year

• Time-up-and-go test

  1 year

Interventions

Prehabilitation BEHAVIORAL

Prehabilitation includes exercise prescription, cognitive function assessment and training, nutritional optimisation at least 4 weeks prior to surgery

Eligibility Criteria

• Age: 50 Years+
• Sex: all
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Local Hong Kong population, usually elderly frail patients with the above criteria, booked for elective major operation and seen at prehabilitation clinic at least 4 weeks prior to procedure

You may qualify if:

• Procedure-specific: major hepatectomy (resection of 3 or more Couimaud's segments), pancreaticoduodenectomy, esophagectomy and radical cystectomy
• Patient-specific: age 50 or above, undergoing elective major procedures, together with one of the followings:
• American Society of Anaesthesiologists physical status score \>=3
• Pre-frail to moderately frail patients with a Clinical Frailty Scale 3-6 at the time of assessment at prehabilitation clinic
• minute walk test distance \<400 meters
• Duke Activity Status Index \<34
• Malnutritional Screening Tool score \>=2

You may not qualify if:

• Patients with unstable angina or unstable cardiac syndrome (New York Heart Association Class IV, critical left main coronary disease, hospitalization for arrhythmias, congestive heart failure or acute coronary syndrome before assessment at prehabilitiation clinic)
• Patients with left ventricular outflow obstruction (severe aortic stenosis, hypertrophic cardiomyopathy)
• Chronic obstructive pulmonary disease GOLD stage IV
• Abdominal aortic aneurysm \>8.0cm or suspected dissecting or leaking aortic aneurysm
• Cognitive deficits unable to comply with study procedures, physical limitations that would prelude rehabilitation and inability to regularly attend prehabilitation sessions.

Sponsors & Collaborators

• Chinese University of Hong Kong: lead

Study Sites (1)

Prince of Wales Hospital

Hong Kong, Hong Kong

Location

Related Publications (1)

• Wong HMK, Qi D, Ma BHM, Hou PY, Kwong CKW, Lee A; Prehab Study Group. Multidisciplinary prehabilitation to improve frailty and functional capacity in high-risk elective surgical patients: a retrospective pilot study. Perioper Med (Lond). 2024 Jan 23;13(1):6. doi: 10.1186/s13741-024-00359-x.

  PMID: 38263053 DERIVED

MeSH Terms

Conditions

Frailty

Interventions

Preoperative Exercise

Condition Hierarchy (Ancestors)

Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Perioperative Care; Patient Care; Therapeutics; Surgical Procedures, Operative; Exercise; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Health Services; Health Care Facilities Workforce and Services

Study Officials

• Man Kin Wong

  Chinese University of Hong Kong

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator, Honorary Clinical Assistant Professor

Study Record Dates

• First Submitted: December 13, 2022
• First Posted: December 29, 2022
• Study Start: November 1, 2020
• Primary Completion: December 31, 2021
• Study Completion: December 31, 2021
• Last Updated: May 31, 2023

Record last verified: 2023-05

Data Sharing

• IPD Sharing: Will not share

Locations

HK (1)