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Singapore's population is ageing, and more elderly people are undergoing elective major surgeries. Frail elderly experience greater functional decline and slower recovery in physical function after surgery compared to non-frail elderly. Preoperative prehabilitation aims to enhance both aerobic capacity and physical strength of elderly to attenuate the post-operative decline in physical function. Singapore General Hospital has a bespoke preoperative program - Prehabilitation for Elderly Frail Patients Undergoing Elective Surgeries (PREPARE), where patients receive physiotherapy education and instructions for home-based unsupervised exercise program (uSEP). A hospital-based supervised exercise program had also been established but the take-up rate was low (7.6%) due to barriers such as cost and accessibility. Perioperative supervised exercise training can effect greater gains in functional capacity and muscle strength compared to no supervision. For the elderly with limited transport options to the hospital, home-based supervised programmes may be more convenient compared to hospital-based supervised programmes, but the former is costlier too. Home-interventions may also empower patients with the skills and confidence to maintain their physical fitness at home, which increases their likelihood of exercising after surgery.
The investigators propose a prospective single-center randomized controlled trial to evaluate the efficacy of preoperative prehabilitation with a home-based supervised exercise program (SEP) for frail elderly patients undergoing major abdominal surgery, compared to the mainstay of clinical practice, which is a home-based uSEP.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Home supervised exercise program | Active Comparator | This group receives standard preoperative physiotherapy education as well a home-exercise instructions. They will also receive 3-4 home visits by physiotherapists between recruitment and surgery, to conduct exercises in their homes. |
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| Home unsupervised exercise program | No Intervention | This group receives standard preoperative physiotherapy education as well a home-exercise instructions. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Home-based supervised exercise program | Other | Combination of aerobic and strength training exercises, in addition to home exercise instructions issued during preoperative physiotherapy education. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in functional walking capacity from baseline to just before surgery, as measured using the 6-minute walk distance. | Distance that the patient can walk in 6 min, along a 15-20m hallway, at a pace that the participants will be tired at the end of the distance. This is a sub-maximal exercise test used to assess aerobic capacity and endurance. The distance covered over a time of 6 minutes is used as the outcome by which to compare changes in performance capacity. | From recruitment to 2-days before surgery |
| Measure | Description | Time Frame |
|---|---|---|
| 30-day in-hospital complications | Classified using the Clavien Dindo Classification | From day of surgery to 30-days afterwards |
| Hospital length-of-stay | Duration that patient stayed in hospital from day of surgery to discharge either to home or step-down care |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Eileen Y Sim | Contact | 93804422 | eileen.sim.y.l@singhealth.com.sg |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Eileen Yilin Sim | Recruiting | Singapore | 169608 | Singapore |
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| From day of surgery until discharge, or up to 6 months after surgery, whichever occurs first |
| Health-related quality of life outcomes (HRQoL) as measured using the 12-Item Short Form Survey (SF-12) | SF-12 is a 12-item questionnaire that assesses generic health outcomes from the patient's perspective, and covers eight domains: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional & mental health. | Day of recruitment, 2 days before surgery, 4 weeks, 8 weeks and 6 months postoperative |
| Health-related quality of life outcomes (HRQoL) as measured using the EQ-5D-3L | The EQ-5D-3L descriptive system comprises the following five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems, some problems, and extreme problems. | Day of recruitment, 2 days before surgery, 4 weeks, 8 weeks and 6 months postoperative |
| Change in 6-minute walking distance | Distance that the patient can walk in 6 min, along a 15-20m hallway, at a pace that the participants will be tired at the end of the distance. This is a sub-maximal exercise test used to assess aerobic capacity and endurance. The distance covered over a time of 6 minutes is used as the outcome by which to compare changes in performance capacity. | Day of recruitment, 2 days before surgery, 4 weeks and 8 weeks postoperative |
| Maximal Inspiratory Pressure (MIP) | The maximal inspiratory pressure reflects the strength of inspiratory muscles. | Day of recruitment, 2 days before surgery, 4 weeks and 8 weeks postoperative |
| 30-second and 1-minute Sit-to-Stands (STS) | The Sit to Stand test reflects lower-extremity strength and endurance. | Day of recruitment, 2 days before surgery, 4 weeks and 8 weeks postoperative |
| Handgrip strength (HGS) | The handgrip strength is a measure of muscular strength or the maximum force/tension generated by one's forearm muscles. It reflects upper body strength and overall strength. | Day of recruitment, 2 days before surgery, 4 weeks and 8 weeks postoperative |
| ID | Term |
|---|---|
| D000073496 | Frailty |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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