Telerehabilitation in Cancer Patients: Optimization of Prehabilitation and Rehabilitation Following Colorectal Resection (CCR)

Telerehabilitation in Cancer Patients: Optimization of Prehabilitation and Rehabilitation Following Colorectal Resection. A Randomized Clinical Trial

This study, titled: Telerehabilitation in Oncology Patients: Optimization of Prehabilitation and Rehabilitation Post-Colorectal Resection. Is a randomized clinical trial conducted at the Royo Villanova Hospital in Zaragoza, Spain. It aims to evaluate the effectiveness of a tele-rehabilitation program in enhancing functional capacity and quality of life for patients undergoing colorectal cancer surgery. Colorectal cancer (CRC) is a highly prevalent malignant tumor that significantly impacts global health and patients' quality of life, particularly after surgery. Prehabilitation and postoperative rehabilitation are crucial for recovery, and telerehabilitation offers a promising alternative to improve outcomes in CRC patients.

Study Overview

• Status: Active, not recruiting
• Conditions: Colorectal Cancer; Telerehabilitation; Physical Therapy
• Intervention / Treatment: Other: Telerehabilitation Program; Other: Booklet-based rehabilitation program

Detailed Description

Study Background and Rationale: Colorectal cancer (CRC) is one of the most prevalent malignant tumors worldwide and a leading cause of cancer-related deaths. Despite advancements in surgical and oncological treatments, patients often experience significant postoperative complications and a decline in their quality of life. Prehabilitation, which aims to enhance a patient's functional capacity before surgery, has been identified as a promising approach to improve postoperative outcomes. However, traditional rehabilitation programs are often limited by patient adherence, accessibility, and the availability of resources, especially for those living in rural or underserved areas.

Objective: The primary objective of this study is to determine whether a 2-week prehabilitation and 4-week post-surgical rehabilitation program delivered via asynchronous telerehabilitation software can improve the functional capacity of patients undergoing colorectal cancer surgery, as measured by the Six Minute Walking Test (6MWT). Secondary objectives include assessing changes in body composition, muscle strength, pulmonary capacity, postoperative complications, psychosocial factors (such as quality of life, anxiety, depression, and sleep quality), adherence to the treatment, patient acceptance of the treatment, and the usability of the telerehabilitation platform.

Study Design: This is a single-blind, parallel-group randomized clinical trial. Fifty-four patients scheduled for colorectal cancer surgery will be recruited and randomly assigned to either the control group, which will receive conventional rehabilitation through a booklet, or the intervention group, which will receive the same rehabilitation program through a digital telerehabilitation platform. Both groups will undergo a comprehensive rehabilitation program including therapeutic education, respiratory exercises, aerobic exercises, and strength training.

Methodology: Patients will be assessed at five time points: pre-intervention, the day before surgery, 21 days post-surgery, 50 days post-surgery, and 3-month follow-up. The telerehabilitation platform will allow patients to access exercise videos and therapeutic content asynchronously, with the ability to communicate with their physiotherapists through the platform for guidance and support. The booklet will allow patients to access the program through pictures and text.

Clinical implications: Telerehabilitation represents an innovative approach to overcoming barriers associated with conventional rehabilitation, particularly in improving accessibility for patients in remote areas. By demonstrating the clinical efficacy of telerehabilitation, this study aims to contribute to the optimization of rehabilitation protocols for oncology patients and to provide a scalable model for integrating digital health solutions into routine clinical practice.

• Study Type: Interventional
• Enrollment (Estimated): 54
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Spain
  • Zaragoza
    • Zaragoza, Zaragoza, Spain, 50015
      • Hospital Royo Villanova

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age between 18 and 80 years.
• Participants who understand Spanish.
• Patients scheduled for colorectal cancer surgery at Royo Villanova Hospital, Zaragoza, Spain.
• Patients attending the first consultation in the General and Digestive Surgery Section under the supervision of Dr. Blas, head of surgery at Royo Villanova Hospital, Zaragoza, Spain.
• Participants with functional independence that allows them to perform walking and pulmonary function tests.
• Patients with a preoperative assessment score of I, II, or III on the American Society of Anesthesiologists (ASA) scale.
• Participants who agree to participate and sign the informed consent form.

Exclusion Criteria:

• Patients older than 80 years.
• Patients with a preoperative ASA score of IV.
• Patients with any injury, pathology, or inflammatory processes that make it impossible to practice exercise.
• Patients with central and/or peripheral neurological diseases that prevent them from following the rehabilitation program.
• Patients with unstable cardiac comorbidities such as arrhythmias, high blood pressure, angina pectoris, or other conditions that contraindicate moderate-intensity training.
• Patients diagnosed with a psychiatric disorder as confirmed by a psychiatrist.
• Patients without access to mobile internet or a computer with internet at home.
• Patients who score ≤ 24 on the Mini-Mental State Examination (MMSE).
• Individuals who are unable to follow oral and written instructions in Spanish.
• Patients who refuse to participate in the study or who have not signed the informed consent form.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention Group. Asynchronous telerehabilitation; Receive a home-based rehabilitation program via an asynchronous digital telerehabilitation platform.	Other: Telerehabilitation Program; Participants in the intervention group will receive a home-based rehabilitation program delivered via an asynchronous digital telerehabilitation platform. The multimodal program is accessible at online platform and it is composed for therapeutic exercises, including aerobic and strength training exercises, aimed at improving functional capacity and quality of life before and after colorectal cancer surgery.; Other Names: Asynchronous Digital Rehabilitation
Active Comparator: Control Group. Booklet-based rehabilitation; Receive a booklet-based rehabilitation program at home through a detailed printed guide (explanatory booklet).	Other: Booklet-based rehabilitation program; Participants in the control group will receive a booklet-based rehabilitation program at home, provided through a detailed printed guide (explanatory booklet). This guide includes instructions in pictures and text for the multimodal program. It is composed for therapeutic exercises, including aerobic and strength training exercises, aimed at improving functional capacity and quality of life before and after colorectal cancer surgery.; Other Names: Printed Guide Rehabilitation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Functional Capacity - Six Minute Walking Test (6MWT)	The primary outcome is the improvement in functional capacity, which will be evaluated using the Six Minute Walking Test (6MWT). This test measures the maximum distance a patient can walk in six minutes along a flat, straight corridor under controlled conditions. The results provide an objective assessment of the patient's functional capacity, reflecting their ability to perform daily activities and their level of postoperative recovery.	Functional capacity will be assessed at four time points: pre-intervention (T1), the day before surgery (T2), 21 days post-surgery (T3), and 50 days post-surgery (T4).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pulmonary Capacity - Spirometry Assessments	Evaluate improvements in pulmonary capacity using spirometry, with a specific focus on measuring Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 second (FEV1) through standardized spirometry techniques.. The aim is to determine whether the tele-rehabilitation program can enhance respiratory function as compared to the standard approach.	Measured at pre-intervention (T1), the day before surgery (T2), 21 days post-surgery (T3), and 50 days post-surgery (T4).
Upper Limb Muscle Strength - Hand Grip Test	Evaluate the muscle strength of the upper limbs using the Hand Grip Test. This assessment will provide data on the effectiveness of the tele-rehabilitation program in enhancing upper limb muscle strength.	Measured at pre-intervention (T1), the day before surgery (T2), 21 days post-surgery (T3), and 50 days post-surgery (T4).
Lower Limb Muscle Strength - Sit to Stand Test	Evaluate the muscle strength of the lower limbs using the Sit to Stand Test. This assessment will provide data on the effectiveness of the tele-rehabilitation program in enhancing lower limb muscle strength.	Measured at pre-intervention (T1), the day before surgery (T2), 21 days post-surgery (T3), and 50 days post-surgery (T4).
Body Composition - Bioelectrical Impedance Analysis and Waist-to-Hip Ratio	Assess changes in body composition, including measurements taken via bioelectrical impedance analysis (BIA) and waist-to-hip ratio. This will help determine if the tele-rehabilitation program leads to significant improvements in body composition compared to the conventional rehabilitation program.	Measured at pre-intervention (T1), the day before surgery (T2), 21 days post-surgery (T3), and 50 days post-surgery (T4).
Postoperative Complications - Comprehensive Complication Index (CCI)	Assess the occurrence and severity of postoperative complications using the Comprehensive Complication Index (CCI). The CCI provides a cumulative score that reflects the overall burden of all complications, ranging from 0 (no complications) to 100 (death). This outcome measure aims to determine whether the tele-rehabilitation program effectively reduces the rate and severity of postoperative complications compared to the standard rehabilitation approach.	Evaluated 3 months post-surgery (T5).
Quality of Life - EuroQol-5D (EQ-5D)	Assess the impact on quality of life using the EuroQol-5D (EQ-5D) instrument. The EQ-5D evaluates five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Scores range from -0.594 to 1, where higher scores indicate better quality of life.	Assessed at pre-intervention (T1), 50 days post-surgery (T4) and 3 months post-surgery (T5).
Anxiety and Depression - Hospital Anxiety and Depression Scale (HADS)	Measure levels of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). The HADS consists of two subscales: anxiety and depression, each ranging from 0 to 21. Higher scores indicate worse outcomes.	Assessed at pre-intervention (T1), 50 days post-surgery (T4) and 3 months post-surgery (T5).
Psychological Adjustment - Mental Adjustment to Cancer Scale (MAC)	Evaluate psychological adjustment to cancer using the Mental Adjustment to Cancer Scale (MAC). The MAC includes subscales such as fighting spirit, helplessness/hopelessness, anxious preoccupation, fatalism, and avoidance. Scores vary by subscale, generally ranging from 0 to 32 for each subscale. Higher scores on positive subscales, such as fighting spirit, indicate better adjustment, while higher scores on negative subscales, such as helplessness/hopelessness, indicate worse adjustment.	Assessed at pre-intervention (T1), 50 days post-surgery (T4) and 3 months post-surgery (T5).
Sleep Quality - Pittsburgh Sleep Quality Index (PSQI)	Assess sleep quality using the Pittsburgh Sleep Quality Index (PSQI). The PSQI measures seven components: sleep duration, sleep disturbances, sleep latency, daytime dysfunction, and more. Scores range from 0 to 21, with higher scores indicating worse sleep quality.	Assessed at pre-intervention (T1), 50 days post-surgery (T4) and 3 months post-surgery (T5).
Adherence to the Tele-Rehabilitation Program	Evaluate compliance with the tele-rehabilitation protocol by tracking the percentage of prescribed sessions completed by participants. Compliance data will be recorded in treatment diaries and through the tele-rehabilitation platform. The compliance rate will be calculated as the proportion of completed sessions out of the total prescribed sessions.	Monitored continuously throughout pre-intervention (T1) - the day before surgery (T2), 21 days post-surgery (T3) - 50 days post-surgery (T4).
Satisfaction with Tele-Rehabilitation Program	Assess participant satisfaction with the tele-rehabilitation program using a standardized satisfaction survey. The survey will be recorded on the tele-rehabilitation platform, and scores will range from 1 to 4, with higher scores indicating greater satisfaction.	Monitored continuously throughout pre-intervention (T1) - the day before surgery (T2), 21 days post-surgery (T3) - 50 days post-surgery (T4).
Incremental Cost-Effectiveness Ratio (ICER) - Cost per QALY	Assess the cost-effectiveness of the tele-rehabilitation program compared to conventional clinical practice by calculating the Incremental Cost-Effectiveness Ratio (ICER). The ICER is expressed in euros per Quality-Adjusted Life Year (QALY). This measure will provide insight into the additional cost per QALY gained with the tele-rehabilitation program.	Evaluated after 3 months post-surgery (T5).
Quality-Adjusted Life Years (QALYs)	Evaluate the quality-adjusted life years (QALYs) gained through the tele-rehabilitation program compared to conventional clinical practice. The QALY is a measure of the value of health outcomes, combining both quantity and quality of life. Scores typically range from 0 (equivalent to death) to 1 (perfect health), with higher scores indicating better outcomes.	Evaluated after 3 months post-surgery (T5).

Collaborators and Investigators

• Sponsor: Instituto de Investigación Sanitaria Aragón
• Collaborators: Universidad de Zaragoza; Universidad San Jorge; Hospital Royo Villanova de Zaragoza
• Investigators: Principal Investigator: Sandra Calvo, PhD, Universidad de Zaragoza

Publications and helpful links

General Publications

• Burgos-Bragado JM, Jimenez-Sanchez C, Brandin-de la Cruz N, Carpallo-Porcar B, Roux-Etheve LL, Blas-Laina JL, Alamillo-Salas J, Gracia Gimeno P, Calvo S. Asynchronous telerehabilitation in prehabilitation and postoperative recovery for colorectal cancer: A protocol for a randomized controlled trial. PLoS One. 2026 Apr 30;21(4):e0333649. doi: 10.1371/journal.pone.0333649. eCollection 2026.

Study record dates

Study Major Dates

• Study Start (Actual): August 30, 2024
• Primary Completion (Actual): April 30, 2026
• Study Completion (Estimated): July 1, 2026

Study Registration Dates

• First Submitted: August 29, 2024
• First Submitted That Met QC Criteria: September 9, 2024
• First Posted (Actual): September 19, 2024

Study Record Updates

• Last Update Posted (Actual): June 12, 2026
• Last Update Submitted That Met QC Criteria: June 10, 2026
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: Quality of life; Physical Therapy; Telerehabilitation; Colorectal Cancer; Functional Recovery; Psychosocial factors; Multimodal program
• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Intestinal Diseases; Gastrointestinal Neoplasms; Digestive System Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Intestinal Neoplasms; Rectal Diseases; Colonic Diseases; Colorectal Neoplasms
• Other Study ID Numbers: UZ-USJ-CCR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No