Protocol for the PREHAB study-Pre-operative Rehabilitation for reduction of Hospitalization After coronary Bypass and valvular surgery: a randomised controlled trial

Andrew N Stammers, D Scott Kehler, Jonathan Afilalo, Lorraine J Avery, Sean M Bagshaw, Hilary P Grocott, Jean-Francois Légaré, Sarvesh Logsetty, Colleen Metge, Thang Nguyen, Kenneth Rockwood, Jitender Sareen, Jo-Ann Sawatzky, Navdeep Tangri, Nicholas Giacomantonio, Ansar Hassan, Todd A Duhamel, Rakesh C Arora, Andrew N Stammers, D Scott Kehler, Jonathan Afilalo, Lorraine J Avery, Sean M Bagshaw, Hilary P Grocott, Jean-Francois Légaré, Sarvesh Logsetty, Colleen Metge, Thang Nguyen, Kenneth Rockwood, Jitender Sareen, Jo-Ann Sawatzky, Navdeep Tangri, Nicholas Giacomantonio, Ansar Hassan, Todd A Duhamel, Rakesh C Arora

Abstract

Introduction: Frailty is a geriatric syndrome characterised by reductions in muscle mass, strength, endurance and activity level. The frailty syndrome, prevalent in 25-50% of patients undergoing cardiac surgery, is associated with increased rates of mortality and major morbidity as well as function decline postoperatively. This trial will compare a preoperative, interdisciplinary exercise and health promotion intervention to current standard of care (StanC) for elective coronary artery bypass and valvular surgery patients for the purpose of determining if the intervention improves 3-month and 12-month clinical outcomes among a population of frail patients waiting for elective cardiac surgery.

Methods and analysis: This is a multicentre, randomised, open end point, controlled trial using assessor blinding and intent-to-treat analysis. Two-hundred and forty-four elective cardiac surgical patients will be recruited and randomised to receive either StanC or StanC plus an 8-week exercise and education intervention at a certified medical fitness facility. Patients will attend two weekly sessions and aerobic exercise will be prescribed at 40-60% of heart rate reserve. Data collection will occur at baseline, 1-2 weeks preoperatively, and at 3 and 12 months postoperatively. The primary outcome of the trial will be the proportion of patients requiring a hospital length of stay greater than 7 days.

Potential impact of study: The healthcare team is faced with an increasingly complex older adult patient population. As such, this trial aims to provide novel evidence supporting a health intervention to ensure that frail, older adult patients thrive after undergoing cardiac surgery.

Ethics and dissemination: Trial results will be published in peer-reviewed journals, and presented at national and international scientific meetings. The University of Manitoba Health Research Ethics Board has approved the study protocol V.1.3, dated 11 August 2014 (H2014:208).

Trial registration number: The trial has been registered on ClinicalTrials.gov, a registry and results database of privately and publicly funded clinical studies (NCT02219815).

Keywords: PREVENTIVE MEDICINE.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Patient flow (CFS, Clinical Frailty Score; 6MWT, 6 min walk test; SPPB, Short Performance Physical Battery Test; PREHAB, Pre-operative Rehabilitation for Reduction of Hospitalization After Coronary Bypass and Valvular Surgery).

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