Falls are common in patients presenting to a dizziness unit. Those with central syndromes are at risk of recurrent and injurious falling. Fall rates and fear of falling should be assessed in balance disorders and used to guide the regimen of rehabilitation therapy. The identification of risk factors would help provide protective measures to these groups of patients.
Background
Frailty is expressed by a reduction in physical capacity, mobility, muscle strength, and endurance. (Pre-)frailty is present in up to 42% of the older surgical population, with an increased risk for peri- and postoperative complications. Consequently, these patients often suffer from a delayed or limited recovery, loss of autonomy and quality of life, and a decrease in functional and cognitive capacities. Since frailty is modifiable, prehabilitation may improve the physiological reserves of patients and reduce the care dependency 12 months after surgery.
Methods
Patients ≥ 70 years old scheduled for elective surgery or intervention will be recruited in this multicenter, randomized controlled study, with a target of 1400 participants with an allocation ratio of 1:1. The intervention consists of (1) a shared decision-making process with the patient, relatives, and an interdisciplinary and interprofessional team and (2) a 3-week multimodal, individualized prehabilitation program including exercise therapy, nutritional intervention, mobility or balance training, and psychosocial interventions and medical assessment. The frequency of the supervised prehabilitation is 5 times/week for 3 weeks. The primary endpoint is defined as the level of care dependency 12 months after surgery or intervention.
Discussion
Prehabilitation has been proven to be effective for different populations, including colorectal, transplant, and cardiac surgery patients. In contrast, evidence for prehabilitation in older, frail patients has not been clearly established. To the best of our knowledge, this is currently the largest prehabilitation study on older people with frailty undergoing general elective surgery.
Trial registration
ClinicalTrials.gov NCT04418271. Registered on 5 June 2020. Universal Trial Number (UTN): U1111-1253-4820
Disability is understood by the World Health Organization (WHO) as the outcome of the interaction between a health condition and personal and environmental factors. Comprehensive data about environmental factors is therefore essential to understand and influence disability. We aimed to identify which environmental factors have the highest impact on the performance of people with mild, moderate and severe difficulties in capacity, who are at risk of experiencing disability to different extents, using data from a pilot study of the WHO Model Disability Survey in Cambodia and random forest regression. Hindering or facilitating aspects of places to socialize in community activities, transportation and natural environment as well as use and need of personal assistance and use of medication on a regular basis were the most important environmental factors across groups. Hindering or facilitating aspects of the general environment were the most relevant in persons experiencing mild levels of difficulties in capacity, while social support, attitudes of others and use of medication on a regular basis were highly relevant for the performance of persons experiencing moderate to higher levels of difficulties in capacity. Additionally, we corroborate the high importance of the use and need of assistive devices for people with severe difficulties in capacity.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.