Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: A prospective randomized controlled trial

Jensen, Bente Thoft; Petersen, Annemette Krintel; Jensen, Jørgen Bjerggaard; Laustsen, Sussie; Borre, Michael

doi:10.3109/21681805.2014.967810

Cited by 121 publications

(164 citation statements)

References 31 publications

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“…Three studies did not specify the time frame of intervention implementation prior to treatment [16][17][18]. Standard care varied according to individual institutions whereby verbal or written instructions were given [15,[19][20][21], physical activity was delivered in the rehabilitation setting post-treatment [22,23], generic risk management and active mobilisation was given [18] or fast-track surgery was implemented [24]. Five studies delivered interventions in the pre-treatment period only [12,17,18,[25][26][27]; the remaining studies continued the interventions during or after treatment.…”

Section: Resultsmentioning

confidence: 99%

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An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

2017

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Purpose The purpose of the study is to systematically review and synthesise randomised controlled trials investigating the effectiveness of prehabilitation compared to usual care for newly diagnosed, adult-onset cancer patients. Methods MEDLINE, EMBASE, PsycINFO, CINAHL and SSCI were searched up to April 2017. Studies were included if disease-related, treatment-related, patient-reported and health service utilisation outcomes were assessed. Two reviewers independently reviewed and appraised the risk of bias of each study. Results Eighteen studies were included. Interventions comprised one or more of the following components: psychological support, education and exercise. Meta-analyses found that pelvic floor muscle training (PFMT) significantly increased odds of continence at 3 months (OR = 3.29, 95% CI = 1.57-6.91), but did not significantly reduce daily pad use at 6 months post-surgery Mean Difference (MD)= ( = − 0.96, 95% CI = − 2.04-0.12) for prostate cancer patients. Although quality of life improved due to PFMT, functional ability or distress did not. Further meta-analyses indicated that presurgical exercise significantly reduced length of hospital stay (MD = − 4.18, 95% CI = − 5.43-− 2.93) and significantly lowered odds of post-surgery complications (OR = 0.25, 95% CI = 0.10-0.66) for lung cancer patients. Psychology-based prehabilitation significantly improved mood, physical wellbeing and immune function for prostate cancer patients and improved fatigue and psychological outcomes and a trend for better quality of life among breast cancer patients. Risk of bias was high for most studies. Conclusions Prehabilitation appears to benefit cancer patients. Rigorous trials are needed to investigate the effectiveness of prehabilitation among other cancer sites and other related effects. The cost-effectiveness of prehabilitation remains unanswered. Implications for cancer survivors Providing interventions earlier in the care pathway may lead to better outcomes for patients during survivorship.

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Section: Resultsmentioning

confidence: 99%

“…The study found no significant benefits for patients in terms of length of hospital stay (p = 0.68), complication incidents (p = 0.47), severity of complications (p = 0.64), hospital readmissions (p = 0.49), mortality (p = 0.84), bowel function restoration (p > 0.05), energy intake (0.60) or protein intake (p = 0.29) [24].…”

Section: Bladder Cancermentioning

confidence: 99%

An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

2017

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“…In one study [36], patients whose functional capacity deteriorated during PET were at higher risk of complications. There was no significant difference in complications between groups in the other studies [37,41] In one study [62], PET increased _ following pre-operative exercise training, as measured using cardiopulmonary exercise testing. All seven of these studies reported data on peak oxygen uptake, with five studies demonstrating a statistically significant improvement following pre-operative exercise training.…”

Section: Cardiorespiratory Fitnessmentioning

confidence: 86%

“…bowel resection, radical cystectomy, abdominal aortic aneurysm repair), the impact of pre-operative exercise training on peri-operative complications is less clear, with interpretation clouded by lack of standardisation in outcome measures. In the systematic review by Hijazi et al [3], three trials that included a variety of abdominal surgical populations recorded complications using the Clavien-Dindo classification, with none of them reporting significant between-group differences [36,37,41]. A recent trial of 144 patients undergoing major abdominal surgery also reported no effect of pre-operative exercise training on the severity of complications assessed using the Clavien-Dindo classification [32]; however, the proportion of patients with postoperative complications was lower (31% vs. 62%; relative risk ratio (95%CI) 0.5 (0.3-0.8)) when complications were defined as any deviation from the normal postoperative course according to the standards of the European Society of Anaesthesiology and European Society of Intensive Care Medicine [42].…”

Section: Peri-operative Clinical Outcomesmentioning

confidence: 99%

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

et al. 2018

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SummaryDespite calls for the routine implementation of pre-operative exercise programmes to optimise patient fitness before elective major surgery, there is no practical guidance for providing safe and effective exercise in this specific context. The following clinical guideline was developed following a review of the evidence on the effects of pre-operative exercise interventions. We developed a series of best-practice and, where possible, evidence-based statements to advise on patient care with respect to exercise training in the peri-operative period. These statements cover: patient selection for exercise training in surgical patients; integration of exercise training into multi-modal prehabilitation programmes; and advice on exercise prescription factors and follow-up. Although we acknowledge that further research is needed to identify the optimal exercise prescription in different clinical scenarios, we urge peri-operative teams to make use of these recommendations. Summary of key recommendations1 Pre-operative exercise training should be offered to patients scheduled for major or complex elective surgery with a view to improving their physical fitness and health status and reducing the risk of peri-operative morbidity and mortality. If resources are limited, priority of referral to preoperative exercise training should go to patients who are at increased risk of peri-operative complications, such as those with low cardiorespiratory fitness.2 Pre-operative exercise training should be offered as part of a multi-modal prehabilitation programme that addresses a variety of peri-operative risk factors including cigarette smoking, excessive alcohol consumption, and anaemia. 3 Healthcare professionals making referrals to a preoperative exercise programme should have basic knowledge about what the programme entails and its potential effects. A pre-operative exercise programme should be presented to the patient by the referring clinician as a fundamental part of their 750

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“…Pre-operative condition and risk profile is yet to be recognized in early survival care plans, and efforts should be made to inform and educate RC patients before surgery in order to reduce well-known late effects. Early nutrition care and a standardized exercise training program supervised by a multiprofessional team may lead to improved physical capacity and thereby a better basis for early ambulation and recovery [10,11]. Both the nutrition agent and physical activity are inter-related anabolic factors and involved in reducing the influence of the metabolic surgical stress response which is known to impact on early recovery and complications [12][13][14].…”

Section: Introductionmentioning

confidence: 98%

Exercise-based pre-habilitation is feasible and effective in radical cystectomy pathways—secondary results from a randomized controlled trial

Jensen

Laustsen

Jensen

et al. 2016

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Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: A prospective randomized controlled trial

Cited by 121 publications

References 31 publications

An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

Exercise-based pre-habilitation is feasible and effective in radical cystectomy pathways—secondary results from a randomized controlled trial

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