Surgical prehabilitation in older and frail individuals: a scoping review

Sadlonova, Monika; Katz, Nicole; Flores, Laura; Celano, Christopher M.; Arnim, Christine A. F. Von; Silver, Julie K.

doi:10.1097/aia.0000000000000394

Cited by 8 publications

(3 citation statements)

References 48 publications

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“…However, high heterogeneity of the included studies regarding the therapeutic interventions, the detected outcome parameters, and the cohorts included limit the validity of these findings. A recently published scoping review came to same conclusion [ 11 ]. The authors summarized that the evidence is supportive of prehabilitation before cardiac procedures in older and frail individuals but there is a need for an adequately powered, randomized, controlled, assessor-blinded intervention trial to assess the benefit of prehabilitation in improving outcomes in older and frail patients [ 11 ].…”

Section: Introductionmentioning

confidence: 69%

“…A recently published scoping review came to same conclusion [ 11 ]. The authors summarized that the evidence is supportive of prehabilitation before cardiac procedures in older and frail individuals but there is a need for an adequately powered, randomized, controlled, assessor-blinded intervention trial to assess the benefit of prehabilitation in improving outcomes in older and frail patients [ 11 ]. Especially high-quality multicenter prehabilitation studies prior to an elective cardiac procedure are needed.…”

Section: Introductionmentioning

confidence: 69%

“…It is clear, that older cardiac patients are in need of additional support in order to ensure that their QoL and functional capacity can be maintained—or even improved—after a cardiac procedure. One form of additional support for older patients is a preparatory program, so-called multimodal prehabilitation, which seeks to improve functional capacity, psychological and physical health prior to the cardiac procedure [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Prehabilitation in older patients prior to elective cardiac procedures (PRECOVERY): study protocol of a multicenter randomized controlled trial

Steinmetz,

Heinemann,

Kutschka

et al. 2023

Trials

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Background Previous studies have demonstrated the efficacy of rehabilitation after a cardiovascular procedure. Especially older and multimorbid patients benefit from rehabilitation after a cardiac procedure. Prehabilitation prior to cardiac procedures may also have positive effects on patients’ pre- and postoperative outcomes. Results of a current meta-analysis show that prehabilitation prior to cardiac procedures can improve perioperative outcomes and alleviate adverse effects. Germany currently lacks a structured cardiac prehabilitation program for older patients, which is coordinated across healthcare sectors. Methods In a randomized, controlled, two-arm parallel group, assessor-blinded multicenter intervention trial (PRECOVERY), we will randomize 422 patients aged 75 years or older scheduled for an elective cardiac procedure (e.g., coronary artery bypass graft surgery or transcatheter aortic valve replacement). In PRECOVERY, patients randomized to the intervention group participate in a 2-week multimodal prehabilitation intervention conducted in selected cardiac-specific rehabilitation facilities. The multimodal prehabilitation includes seven modules: exercise therapy, occupational therapy, cognitive training, psychosocial intervention, disease-specific education, education with relatives, and nutritional intervention. Participants in the control group receive standard medical care. The co-primary outcomes are quality of life (QoL) and mortality after 12 months. QoL will be measured by the EuroQol 5-dimensional questionnaire (EQ-5D-5L). A health economic evaluation using health insurance data will measure cost-effectiveness. A mixed-methods process evaluation will accompany the randomized, controlled trial to evaluate dose, reach, fidelity and adaptions of the intervention. Discussion In this study, we investigate whether a tailored prehabilitation program can improve long-term survival, QoL and functional capacity. Additionally, we will analyze whether the intervention is cost-effective. This is the largest cardiac prehabilitation trial targeting the wide implementation of a new form of care for geriatric cardiac patients. Trial registration German Clinical Trials Register (DRKS; http://www.drks.de; DRKS00030526). Registered on 30 January 2023.

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Section: Introductionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

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