None listed
Conditions
Brief summary
The aim of this study is to address the knowledge gaps relating to prehabilitation in older frail patients having hip or knee surgery, and to explore the opportunities of delivering home-based preoperative care through digital technology. Patients will be randomly allocated to a treatment group. One group will receive standard preoperative care before their surgery. The other group will receive standard care plus the prehabilitation program before their surgery. This study also acts to inform future research in frail patients undergoing these surgeries to optimise post-operative outcomes.
Interventions
Standard preoperative care plus prehabilitation is defined as:
1. Delivery of standard preoperative care
2. Face-to-face (FTF) review within 3-6 months of planned surgery, to confirm and assess:
a. Sarcopaenia: grip strength, 30 second sit-to-stand (STS), timed-up-and-go (TUG), and the de Morton Mobility Index (DEMMI)
b. Nutrition screening via malnutrition screening tool (MST). If screen positive, further malnutrition classification using the 7-point Subjective Global Assessment (SGA), lean mu
Standard preoperative care plus prehabilitation is defined as: 1. Delivery of standard preoperative care 2. Face-to-face (FTF) review within 3-6 months of planned surgery, to confirm and assess: a. Sarcopaenia: grip strength, 30 second sit-to-stand (STS), timed-up-and-go (TUG), and the de Morton Mobility Index (DEMMI) b. Nutrition screening via malnutrition screening tool (MST). If screen positive, further malnutrition classification using the 7-point Subjective Global Assessment (SGA), lean muscle mass, body mass index (BMI_ and serum albumin and transthyretin levels c. Smoking status Y/N. If screen positive, further smoking classification using the Heaviness of Smoking Index (HSI). 3. Intervention is dependent on the above findings: a. All patients will undergo a targeted sarcopaenia program. This program will be delivered individually. This consists of an initial 60 minute FTF physiotherapy review. The patient will be assessed by the physiotherapist using the revised BORG RPE (Borg rating of perceived exertion) scale aiming for an exercise intensity of 3 (moderate) and allocated to 2x ability-adjusted exercise programs focusing on cardiovascular and strength exercises. Patients will complete 4 x 30 minute sessions per week. Some of the exercises in the cardiovascular program include getting in and out of bed, walking, marching on the spot, punching the air and steps ups. Some of the exercises in the strength program include heel raises, knee extensions, hip flexion, shoulder press, bicep curls and upright row. Education on safe completion of the program, progression through the program and measurement of adherence via mobile phone app is provided during this session. The app being used has been designed specifically for this study and is called "Monash Prehab". b. The exercise program will continue via a tele-health supported, home-based exercise program over the course of 12 weeks with 3x telehealth delivered physiotherapy sessions at weeks 2, 4, 8. The sessions will assess adherence to the program, ongoing education as required, progression of exercises as required and sessions 15-30 minutes in duration.
Sponsors
Monash Health
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
• Patients > 65 years of age, any gender • Screen positive for frailty (FRAIL scale) • Planned for elective unilateral hip or knee arthroplasty within 3-6 months • Able to access and operate a mobile phone • Able to participate successfully in a home-based exercise program
Exclusion criteria
• Bilateral or redo procedures • Any condition or circumstances preventing accurate completion of prehabilitation programs such as psychological, social, physical or technological. This does not automatically exclude cultural and linguistically diverse (CALD) patients and interpreter services will be employed to ensure capture of this important demographic.
Outcome results
None listed