AzTrials
AzTrials

Surgical PatientsNCT04155346

Prehab for Surgery

A study testing Exercise, nutritional optimization, and psychoeducation in people with Surgical Patients and Preoperative Care, run by University of Toronto at 1 site in Canada.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
Search all trials

Trial summary

Surgical prehabilitation is the process of enhancing one's physical function and mental capacity to enable him/or her to withstand the stressor of surgery. Prehabilitation can be achieved via optimizing physical fitness, nutrition, and psychological health. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Surgical Patients, Preoperative Care
What is being tested?
Exercise, nutritional optimization, and psychoeducation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
150 participants
Where
1 siteCanada
Study dates
1 Nov 2019to 31 Dec 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Planned for surgery at the University Health Network
  • Fluent in English
  • Referred by their surgeon with indication for prehabilitation as per the surgeon's clinical impression (i.e. higher-than-average risk candidate; marginal candidate for surgery due to limited physiologic reserve; frail; deconditioned; or other reason with explanation.

Who cannot join

None listed.

Trial locations and contacts

1 site in 1 country.

Canada1 site
  • University Health Network

    Toronto, Ontario, M5G 2C4

Other trials in Canada

About this study

Official title: Feasibility and Effectiveness of Prehabilitation in High-risk Surgical Patients

Surgical prehabilitation is the process of enhancing one's physical function and mental capacity to enable him/or her to withstand the stressor of surgery. Prehabilitation can be achieved via optimizing physical fitness, nutrition, and psychological health. Studies have shown that prehabilitation may prevent complications during and after surgery, reduce hospital length of stay, and improve postoperative recovery. Despite the growing interest in the field of prehabilitation, little is understood about how to implement prehabilitation an integrated clinical service. This study will examine the effect of a prehabilitation program that includes exercise, psychological, and nutritional optimization that emulates clinical integration pathways. Participants of this study will have a choice of participating in facility-based prehabilitation (FBP) or home-based prehabilitation (HBP) depending on their needs/accessibility to the Toronto General Hospital. Participant outcomes will be measured using standardized fitness testing, self-report questionnaires, and medical record reviews at baseline, one week preoperatively, and at 30 and 90 days postoperatively. A comprehensive assessment of feasibility will also be conducted to better understand facilitators and barriers to clinical integration.

Read the detailed description

There is growing interest in the role of prehabilitation to reduce surgical risk, attenuate surgery-related deconditioning, and facilitate postoperative recovery. Compared to the postoperative setting, initiating health interventions preoperatively is proposed as an important strategy to improve health outcomes because: i) it targets modifiable risk factors for surgical complications; ii) patients may be more physically and/or psychologically capable of affecting change in health status compared to the early postoperative period; iii) wait times prior to surgery may be several weeks thus representing an opportunity to proactively invest in their recovery; and iv) patients may be sensitized to the importance of adverse health behaviours that may have contributed to the need for surgery (i.e. a 'teachable moment'). The potential benefit of prehabilitation extends beyond potential gains in health from baseline to surgery, but also includes the prevention or attenuation of deconditioning that patients experience during the postoperative period. The findings of recent systematic reviews and meta-analyses assessing the benefits of prehabilitation interventions in surgical patients provide support for their efficacy in improving physical fitness, length of stay, surgical complication rates, and health-related quality of life (HRQOL).

While previous interventional studies have demonstrated promising findings, little is known about how feasible it is to integrate prehabilitation into standard of care for people awaiting surgery. This study intends to employ intervention design features previously shown to be feasible and efficacious and employs a hybrid effectiveness-implementation trial design model to assess feasibility of clinical integration.

Being tested
Exercise, nutritional optimization, and psychoeducation
Keywords
Exercise, Nutrition, Psychology, Prehabilitation
Medical subject headings
Motor Activity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Exercise, nutritional optimization, and psychoeducationBehavioural

    Multimodal prehabilitation including exercise, nutrition, and stress-management delivered via a facility-based or home-based model

Study groups in NCT04155346
Study groupRoleWhat they receive
Facility-based prehabilitation (FBP)ExperimentalExercise * Three supervised exercise training sessions of aerobic and resistance exercises. Includes high-intensity interval aerobic training and whole-body resistance exercises (60 min/session) * Specific exercises will also be prescribed to prepare regional and/or compensatory tissues for surgery * Exercise session will be supervised by a Registered Kinesiologist/Exercise Physiologist Nutrition * Participants will receive an individualized nutrition assessment and counselling within the first week of prehabilitation and again in the week prior to surgery * All sessions will conducted by a Registered Dietitian (60 min/session) * Participants will also receive 20g of protein supplementation daily Stress management and behavioural support * Participants will be scheduled for a psychoeducation session within the first week of prehabilitation and again in the week prior to surgery * All sessions will conducted by a psychologist (60 min/session)
Receives: Behavioral: Exercise, nutritional optimization, and psychoeducation
Home-based prehabilitation (HBP)ExperimentalExercise * Three unsupervised, home-based exercise training sessions of aerobic and resistance exercises. Includes continuous moderate-intensity aerobic training and whole-body resistance exercises (60 min/session) * Specific exercises will also be prescribed to prepare regional and/or compensatory tissues for surgery * Exercise session will be supervised by a Registered Kinesiologist/Exercise Physiologist Nutrition * Participants will receive an individualized nutrition assessment and counselling within the first week of prehabilitation and again in the week prior to surgery * All sessions will conducted by a Registered Dietitian (60 min/session) * Participants will also receive 20g of protein supplementation daily Stress management and behavioural support * Participants will be scheduled for a psychoeducation session within the first week of prehabilitation and again in the week prior to surgery * All sessions will conducted by a psychologist (60 min/session)
Receives: Behavioral: Exercise, nutritional optimization, and psychoeducation
Usual CareNo intervention- This group will receive no additional intervention from the routine care.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Referral and Enrollment Data

    • The number of eligible patients per month who consent for surgery will be ascertained via the preadmission clinic databases.
    • The total number of referrals received from surgeons.
    • The number of patients that agree to participate in the prehabilitation program.
    • Demographics, disease characteristics, and treatment type will be captured for prehabilitation participants
    • Referred patients who decline participation in the study will be compared to all consenting participants using information provided on the referral form
    • For those who fail screening or decline participation, we will log their demographic and reasons for non-participation.

    Measured: Baseline

  2. Window of opportunity

    The 'prehabilitation window' will be recorded and is operationally defined as the time from program referral to the date of surgery. We will also describe the total preoperative period (time between consent for surgery and date of surgery) and prehabilitation program duration (time from program initiation to surgery). Each of these periods will be recorded in days.

    Measured: Baseline to surgery

  3. Intervention adherence and fidelity

    • Adherence for FBP participants will be recorded via attendance to each in-person session. Fidelity and adherence will be further measured by detailed recording of performance on the aerobic and resistance training components of the exercise sessions.
    • HBP participants will be contacted weekly via telephone or email for adherence recording by the research coordinator. A logbook will be used to self-report HBP participants' home-based exercise that contains specific fields to capture all session details.
    • Adherence to stress management and utilization of smoking cessation tools (as required) will be recorded weekly using a logbook within the participant manuals. This includes the number of relaxation sessions per week; compliance with dietary recommendations for dietary behaviours, protein supplementation, and for smokers, the tools used, and the number of times accessed.

    Measured: Baseline to surgery

  4. Study retention

    • The frequency of drop-out during program participation will be documented including reasons for drop-out. Descriptive statistics for demographic data and reasons will be used to describe program completers and drop-outs.

    Measured: Baseline, 1 week prior to surgery, 30- and 90-day postoperatively

  5. Barriers and facilitators

    Qualitative content analysis on barriers and facilitators for prehabilitation participation and engagement will be conducted using semi-structured interviews. Both participants of prehabilitation and usual care will be asked to participate in interviews via telephone or in-person. To reach saturation for identifying meta-themes within a heterogenous population, sample of has been suggested 15 for the collection of prevalent and more salient ideas.

    Measured: 30-day postoperatively

  6. Safety and adverse events

    Any safety or adverse events related to the prehabilitation intervention will be reported at each in-person session for FBP participants and during weekly telephone calls with HBP participants. Reporting and grading will follow the Common Terminology Criteria for Adverse Events version 5.0.

    Measured: Baseline to surgery

  7. Economic feasibility (hospital perspective)

    A cost impact on the perspective of the hospital will be conducted based on primary hospital length of stay, readmission, and readmission length of stay. This will be used to determine cost differences between those that participate in prehabilitation (FBP and HBP) compared to usual care.

    Measured: Baseline, 1 week prior to surgery, 30- and 90-day postoperatively

  8. Economic feasibility (patient perspective)

    Patient-perspective costing will be measured by a patient-reported cost-diary. This includes: direct healthcare cost (i.e. visits to the general practice, specialists care, unities applied to prescribed medication); direct non-health care costs (i.e. cost of over-the-counter medication, cost of health activities, hours of paid and unpaid household help, transportation, and value of other out-of-pocket expenses, with specifics on exercise-related expenses)l and indirect costs (i.e. number of days absent from work, days lost from housekeeping, and other daily activities).

    Measured: Baseline, 1 week prior to surgery, 30- and 90-day postoperatively

Secondary outcomes (8)
  1. Hospital length of stay

    Postoperative length of stay will be recorded from the patient's medical record. This will be calculated from the date of surgery until to the date of discharge from the hospital and recorded in hours.

    Measured: Up to 90-days postoperatively

  2. Postoperative complications and mortality

    Complications, including mortality, will follow the Clavien-Dindo classification. Any health event that requires readmission will also be documented.

    Measured: Up to 90-days postoperatively

  3. Changes in aerobic functional capacity

    Aerobic functional capacity will be measured using the Six-Minute Walk Test (6MWT). Total distance travelled for 6 minutes will be recorded. Measured only in participants of prehabilitation.

    Measured: Baseline, 1 week prior to surgery, 30- and 90-day postoperatively

  4. Changes in musculoskeletal functional capacity

    Musculoskeletal functional capacity will be assessed via grip strength. Peak isometric force generated for both arms will be recorded in kg-force. Measured only in participants of prehabilitation.

    Measured: Baseline, 1 week prior to surgery, 30- and 90-day postoperatively

  5. Changes in body composition

    Body composition will be measured via bioelectric impedance analysis using mBCA 514 (Seca, Hamburg, Germany). Body fat percentage, fat and fat free mass, impedance, resistance, and phase angle will be recorded. Measured only in participants of prehabilitation.

    Measured: Baseline, 1 week prior to surgery, 30- and 90-day postoperatively

  6. Changes in HRQOL

    HRQOL will be measured by Short Form-12 Health Survey (SF-12) and the EuroQol-5 Dimension (EQ5D). Measured only in participants of prehabilitation.

    Measured: Baseline, 1 week prior to surgery, 30- and 90-day postoperatively

  7. Changes in depression

    Depression will be assessed using the Patient Health Questionnaire (PHQ-9). Measured only in participants of prehabilitation.

    Measured: Baseline, 1 week prior to surgery, 30- and 90-day postoperatively

  8. Changes in diet

    Changes in diet and healthy eating practices will be measured by the 3-day diet record. Measured only in participants of prehabilitation.

    Measured: Baseline and 1 week prior to surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Nov 2019
  2. Study start1 Nov 2019
  3. Primary completion1 Mar 2022
  4. Study completion31 Dec 2024 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Non-randomised
Intervention model
Parallel groups
Model description
Effectiveness-Implementation hybrid model
Masking
None (open label)
Enrolment
150 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04155346
Sponsor's protocol ID
19-5573
Status last verified
May 2024
First submitted
30 Oct 2019
Last updated
8 May 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A study testing Exercise, nutritional optimization, and psychoeducation in people with Surgical Patients and Preoperative Care, run by University of Toronto at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 0 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 8 May 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Referral and Enrollment Data (time frame: Baseline). The study lists 8 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 May 2024.

Free account

Keep searching with a free account

You’ve used your 3 free searches for this session. Log in or create a free AzTrials account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in