Development of a reconditioning program for elderly abdominal surgery patients: the Elder-friendly Approaches to the Surgical Environment-BEdside reconditioning for Functional ImprovemenTs (EASE-BE FIT) pilot study

Alyssa McComb, Lindsey M Warkentin, Margaret L McNeely, Rachel G Khadaroo, Alyssa McComb, Lindsey M Warkentin, Margaret L McNeely, Rachel G Khadaroo

Abstract

Background: Elderly individuals who are hospitalized due to emergency abdominal surgery spend over 80% of their recovery time in bed, resulting in early and rapid muscle loss. As these elderly individuals have a lower physiological reserve, the impact of muscle wasting on function may be profound. The objectives of this study are to (1) create an independently led post-surgical reconditioning program and (2) pilot its implementation, while assessing the feasibility and safety of the program.

Methods: The BE FIT program was generated with hospital rehabilitation staff to target lower limb strength, balance, and endurance. This pilot study was assessed using a sequential before and after trial, with a cohort of patients aged ≥ 65 years enrolled in the Elder-friendly Approaches to the Surgical Environment (EASE) study. Change in 30-s sit-to-stand performance between postoperative day 2 and discharge was compared between Usual Care pre- and post-BE FIT participants.

Results: A total of 66 patients participated in the sub-study, 33 Usual Care and 33 BE FIT. Mean (SD) age was 76.2 (8.78); 44 (67%) were female, with 11 (17%) reporting mild/moderate frailty on the CHSA Clinical Frailty Scale. BE FIT participants had a median of three rehab days and self-reported completing an average of 83% of the exercises. The adjusted between group difference showed that the BE FIT patients were able to complete more stands than the Usual Care (1.9 stands (0.94), p = 0.05). There were no reported adverse events.

Conclusion: The reconditioning program was shown to be safe and feasible within the hospital setting for the elderly emergency abdominal surgery patients. More rigorous assessment is needed to confirm this effectiveness and to better assess patient adherence to self-directed exercise.

Trial registration: Registration #NCT02233153 through ClinicalTrials.gov. Registered September 8, 2014.

Keywords: Abdominal; Bed rest; Elderly; Emergency; Physiotherapy; Reconditioning; Rehabilitation; Surgery.

Conflict of interest statement

The full protocol of the EASE study is published, and the Human Research Ethics Boards of the University of Alberta granted ethics approval (Pro00047180) [18]. Informed consent was given by patients after a thorough explanation from our research coordinator and prior to enrollment in the EASE-BE FIT protocol.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Functional status outcomes pre- and post-BE FIT. TUG, Timed Up and Go. *p < 0.05 compared to Usual Care, after adjusting for sex, CHSA Clinical Frailty Scale, and surgery type

References

    1. PomPei P. Geriatric review syllabus—a core curriculum in geriatric medicine. New York: American Geriatrics Society; 2006.
    1. Robinson TN, et al. Accumulated frailty characteristics predict postoperative discharge institutionalization in the geriatric patient. J Am Coll Surg. 2011;213:37–42. doi: 10.1016/j.jamcollsurg.2011.01.056.
    1. Kwok AC, et al. The intensity and variation of surgical care at the end of life: a retrospective cohort study. Lancet. 2011;378(9800):1408–1413. doi: 10.1016/S0140-6736(11)61268-3.
    1. Gillick MR, Serrell NA, Gillick LS. Adverse consequences of hospitalization in the elderly. Soc Sci Med. 1982;16:1033–1038. doi: 10.1016/0277-9536(82)90175-7.
    1. Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med. 1993;118:219–223. doi: 10.7326/0003-4819-118-3-199302010-00011.
    1. Inouye SK, et al. A controlled trial of a nursing-centered intervention in hospitalized elderly medical patients: the Yale Geriatric Care Program. J Am Geriatr Soc. 1993;41:1353–1360. doi: 10.1111/j.1532-5415.1993.tb06487.x.
    1. Turrentine FE, et al. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203(6):865–877. doi: 10.1016/j.jamcollsurg.2006.08.026.
    1. Lidsky ME, et al. Advanced age is an independent predictor for increased morbidity and mortality after emergent surgery for diverticulitis. Surgery. 2012;152(3):465–472. doi: 10.1016/j.surg.2012.06.038.
    1. Joseph B, et al. Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA Surg. 2014;149(8):766–772. doi: 10.1001/jamasurg.2014.296.
    1. Nygaard IE, Hamad NM, Shaw JM. Activity restrictions after gynecologic surgery: is there evidence? Int Urogynecol J. 2013;24(5):719–724. doi: 10.1007/s00192-012-2026-2.
    1. Mohanty S, et al. Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg. 2016;222(5):930–947. doi: 10.1016/j.jamcollsurg.2015.12.026.
    1. Pearsall E, McCluskey S, Aarts MA, McLeod R. Enhanced Recovery After Surgery: ERAS for All. 2017. Retreived from .
    1. Gustafsson UO, et al. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg. 2011;146(5):571–577. doi: 10.1001/archsurg.2010.309.
    1. Kisialeuski M, et al. Enhanced recovery after colorectal surgery in elderly patients. Videosurgery Miniinvasive Tech. 2015;10(1):30–36. doi: 10.5114/wiitm.2015.48697.
    1. Browning L, Denehy L, Scholes RL. The quantity of early upright mobilisation performed following upper abdominal surgery is low: an observational study. Aust J Physiother. 2007;53(1):47–52. doi: 10.1016/S0004-9514(07)70061-2.
    1. Etzioni DA, et al. The aging population and its impact on the surgery workforce. Ann Surg. 2003;238:170–177.
    1. Symons TB, Swank AM. Exercise testing and training strategies for healthy and frail elderly. ACSMs Health Fit J. 2015;19(2):32–35.
    1. Khadaroo RG, et al. Optimizing senior’s surgical care—Elder-friendly Approaches to the Surgical Environment (EASE) study: rationale and objectives. BMC Health Serv Res. 2015;15(1):338. doi: 10.1186/s12913-015-1001-2.
    1. Rockwood K, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489–495. doi: 10.1503/cmaj.050051.
    1. Rehab measures: 30 second sit to stand test. January 31, 2014 [cited 2015 June 10, 2015]; Available from: .
    1. Barry E, et al. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta- analysis. BMC Geriatr. 2014;14 10.1186/1471-2318-14-14.
    1. Wright AA, et al. A comparison of 3 methodological approaches to defining major clinically important improvement of 4 performance measures in patients with hip osteoarthritis. J Orthop Sports Phys Ther. 2011;41(5):319–327. doi: 10.2519/jospt.2011.3515.
    1. Huang SL, et al. Minimal detectable change of the timed “up & go” test and the dynamic gait index in people with Parkinson disease. Phys Ther. 2011;91(1):114–121. doi: 10.2522/ptj.20090126.
    1. Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999;70(2):113–119. doi: 10.1080/02701367.1999.10608028.
    1. Steffen TM, Hacker TA, Mollinger L. Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. 2002;82(2):128–137. doi: 10.1093/ptj/82.2.128.
    1. Munin MC, et al. Early inpatient rehabilitation after elective hip and knee arthroplasty. JAMA. 1998;279(11):847–852. doi: 10.1001/jama.279.11.847.
    1. Jones CT, et al. A randomised controlled trial of an exercise intervention to reduce functional decline and health service utilisation in the hospitalised elderly. Australas J Ageing. 2006;25(3):126–133. doi: 10.1111/j.1741-6612.2006.00167.x.
    1. Sullivan DH, et al. Progressive resistance muscle strength training of hospitalized frail elderly. Am J Phys Med Rehabil. 2001;80(7):503–509. doi: 10.1097/00002060-200107000-00007.
    1. Roma MF, et al. Effects of resistance training and aerobic exercise in elderly people concerning physical fitness and ability: a prospective clinical trial. Einstein (Sao Paulo) 2013;11(2):153–157. doi: 10.1590/S1679-45082013000200003.
    1. Slaughter SE, Estabrooks CA. Optimizing the mobility of residents with dementia: a pilot study promoting healthcare aide uptake of a simple mobility innovation in diverse nursing home settings. BMC Geriatr. 2013;13(1):110. doi: 10.1186/1471-2318-13-110.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere