- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03709511
Perioperative Rehabilitation of Cardiac Valvular Surgery (PORT)
A Randomized, Open-label, Controlled Trial on Perioperative Rehabilitation of Cardiac Valvular Surgery
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The PORT study is a randomized, open-label, controlled trial using assessor blinding and intention-to-treat analysis. To date, no high-quality study has prospectively examined the impact of perioperative CR in the Chinese population undergoing cardiac surgery. Thus, the PORT trial has been designed to address a cardiac rehabilitation study in line with the actual situation in China. The investigators have used the Standard Protocol Items: Recommendations for Intervention Trials (SPIRIT) guidelines in reporting this clinical trial.
Eligible patients are invited to a face-to-face meeting to confirm study eligibility and introduce the study objectives. The screened candidates will sign the written informed consent after they confirm their willingness to participate. Baseline data are collected subsequently. Then, the intervention group will receive perioperative rehabilitation interventions targeted at the optimization of the postoperative outcomes, This specialized approach, the PORT protocol, contains four key elements: education, inspiratory muscle training (IMT), active cycle of breathing techniques (ACBT), and early mobilization (EM). Patients will be evaluated during hospitalization for study outcomes and 3 months after surgery.
After collection of baseline data, central randomization is conducted on a web-based interface (http://crdms.echobelt.org/) using a computer-generated randomized treatment allocation schedule. The randomization is stratified based on patients' age (<60, 60-75, and >75 years), left ventricular ejection fraction (<40%, 40%-50%, and >50%), and lung function (GOLD stage 1, 2, 3 and 4) with a permuted scheme with blocks of varying sizes, which is concealed from the investigators to avoid selection bias. Thus, neither investigators and patients nor relatives can influence the group the patients are allocated. Personal information about potential and enrolled patients will be collected electronically and shared in a database accessible only within the project group for those responsible for patient inclusion, in order to protect confidentiality before, during, and after the trial.
The investigators are performing a randomized trial stating that the mean in the intervention and the control groups are the same with a power of 95%, and a type I error probability of 5%. Data from the pilot study (to be submitted) showed that the incidence in the primary endpoint was 13.56% (intervention group) versus 21.21% (control group). The inclusion of 400 participants is needed in the experimental intervention group, and 400 in the control group (a total of 800 participants) to be able to reject the null hypothesis. The trial will randomly allocate 800 patients, 1:1 intervention to the control group, using central randomization, blinded outcome assessment, and statistical analyses. The intervention consists of education, inspiratory muscle training (IMT), active cycle of breathing techniques (ACBT), and early mobilization (EM), intervention versus treatment as usual, with blinded outcome assessment.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Guangdong
-
Guangzhou, Guangdong, China
- Recruiting
- Guangdong General Hospital
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion criteria:
Aged from 18 to 75 years. Scheduled for elective mitral and/or aortic valve repair/replacement. New York Heart Association Classification (NYHA) I-III.
Exclusion criteria:
Complicated with preoperative endocarditis and/or pneumonia. Requiring emergency surgery. Enrolled in another clinical trial. Severe liver failure (Child-Turcotte-pugh classification ≥ B). Dialysis-dependent renal failure. Residual neurological and musculoskeletal impairment. Irregular vital signs (heart rate: < 40 or > 120 bpm at rest; blood pressure: systolic blood pressure > 200 mm Hg or diastolic pressure > 110 mm Hg; T: ≥ 38.5 or ≤ 36◦C; RR: >40 bpm; SpO2 ≤ 90%).
Unwilling or unable to sign the informed consent.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Conventional Treatment Group
Participants in the control group will receive the usual care protocol.
On the day of admission, a registered nurse in cardiac ward will provide operating skills of deep breathing, cough exercises, and incentive spirometry, then patients will be instructed to perform the respiratory exercise as much as they can during the hospitalization without supervision.
These participants will not receive additional rehabilitation interventions, unless individual indications are present.
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Active Comparator: Cardiac Rehabilitation Group
The intervention group will receive the PORT protocol, contains education, IMT, ACBT, EM. Participants will be provided information about the cardiac surgery and adverse effect on postoperative recovery, and the importance of PORT program. An inspiratory threshold-loading device is used for IMT. Participants will be instructed to breathe in as forcefully as possible before slowly breathing out five times and then rest for one minute, followed by another set of five breaths. Patients will complete three sessions of ACBT consisting of breathing control, thoracic expansion exercises and forced expiratory techniques. The mobilization protocol will be performed via a progressive approach, consisting of 6 steps. EM will be personalized to each patient. |
perioperative rehabilitation consists of education, inspiratory muscle training, active cycle of breathing techniques, and early mobilization.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
composite end point of in-hospital all-cause death, pulmonary complications and the ratio of postoperative hospitalization longer than 7 days.
Time Frame: Through hospitalization (up to 2 months)
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the composite of in-hospital all-cause death and pulmonary complications, such as pulmonary infection, postoperative hospitalization days.
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Through hospitalization (up to 2 months)
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
incidence of all-cause death in 3 months
Time Frame: 3 months
|
incidence of all-cause death at 3-month follow-up.
|
3 months
|
Individualized Short Form-36 (SF-36) living quality Scores in 3 months
Time Frame: 3 months
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Scores from the self-administered SF-36 living quality questionnaire are measured.
Higher mean scores reflect better outcomes.
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3 months
|
length of ICU treatment
Time Frame: Through hospitalization (up to 2 months)
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total length of treatment at Intensive Care Unit
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Through hospitalization (up to 2 months)
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total length of in-hospital stays
Time Frame: Through hospitalization (up to 2 months)
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total length of in-hospital stays
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Through hospitalization (up to 2 months)
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length of bed rest
Time Frame: Through hospitalization (up to 2 months)
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length of bed rest Description: post-operative duration of bed rest until off-bed activity supervised by rehabilitation therapists.
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Through hospitalization (up to 2 months)
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Incidence of Treatment-Emergent Adverse Events [Emerging Arrhythmia or/and Muscle Injury or/and Acute Heart Failure]
Time Frame: Through hospitalization (up to 2 months)
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The evaluation of Treatment-Emergent Adverse Events during hospitalization: Emerging Arrhythmia or/and Muscle Injury or/and Acute Heart Failure.
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Through hospitalization (up to 2 months)
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Anxiety and depression in 3 months
Time Frame: 3 months
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anxiety measured by Generalized Anxiety Disorder scale (GAD-7) and depression measured by Patient Health Questionnaire-9 (PHQ-9) in 3 months
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3 months
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Collaborators and Investigators
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- GDCR2017143H
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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