AzTrials
AzTrials

Coronary Artery Bypass GraftNCT03299101

Pilot Testing a Home-Based Rehabilitation Intervention Designed to Improve Outcomes of Frail Veterans Following Cardiothoracic Surgery

A study testing Prehabilitation in people with Coronary Artery Bypass Graft and Non-cardiac Thoracic Surgery, run by VA Office of Research and Development at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

Frail Veterans are at increased risk for poor surgical outcomes, and as the Veteran population grows older and more frail, there is a critical need to identify effective strategies for reducing surgical risks for these patients. Read more about this study

Who is it for?
Any age
What is being tested?
Prehabilitation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
35 participants
Where
1 siteUnited States
Study dates
22 Nov 2017to 30 Sep 2020
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Veteran patient scheduled for Coronary artery bypass graft (CABG), valve surgery, or other non-cardiac thoracic surgery;
  • Demonstrate at least mild frailty (e.g., Risk Analysis Index [RAI]>=16).
  • Physician/provider request for patients with RAI<16.

Who cannot join

  • Emergent, urgent, or otherwise time-sensitive surgery that precludes prehabilitation;
  • Unstable or recent unstable cardiac syndrome as defined by (a) acute coronary syndrome within 6 weeks; (b) decompensated heart failure; (c) New York Heart Association Class IV Heart Failure; (d) unstable angina; (e) Canadian Cardiovascular Society Class IV symptoms; (f) critical left main coronary disease; (g) clinically significant arrhythmias,
  • Severe valvular heart disease: (a) severe aortic or mitral stenosis (aortic or mitral valve area <1.0 cm2 or mean gradient >40 or >10 mm Hg, respectively)
  • Dynamic LV (Left Ventricle) outflow obstruction
  • Physical, cognitive, social or logistical limitations preventing participation in the prehabilitation regimen, including:
  • Patients who require surrogate consent for the planned surgery
Show all 11Show fewer
  • Patients with court orders of incompetence or clinical determinations of incapacity documented in the medical record
  • Clinical exam by study physician consistent with incapacity
  • Patients who at any time during prehabilitation or longitudinal follow up demonstrate insufficient cognitive capacity to safely and effectively carry out the prescribed activities.
  • Unable to speak English.
  • Surgery is cancelled by IMPACT clinic or surgeon due to unacceptable risk.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA

    Pittsburgh, Pennsylvania, 15240

Other trials in United States

About this study

Official title: Pilot Testing a Home-based Rehabilitation Intervention Designed to Improve Outcomes of Frail Veterans Following Cardiothoracic Surgery

Frail Veterans are at increased risk for poor surgical outcomes, and as the Veteran population grows older and more frail, there is a critical need to identify effective strategies for reducing surgical risks for these patients. Prior research shows that inter-disciplinary rehabilitation strategies deployed after surgery enhance recovery and improve outcomes by building strength and improving nutrition. The investigators believe that similar improvements may be obtained by using similar interventions before surgery to "prehabilitate" patients' capacity to tolerate the stress of surgery. The proposed research will examine the feasibility of a new, home-based prehabilitation intervention aimed at improving surgical outcomes after cardiothoracic surgery through preoperative exercise training and nutritional supplementation. Findings from the study will inform the design of a larger randomized controlled trial of the prehabilitation intervention. If proven effective, prehabilitation could benefit as many as 42,000 frail Veterans who are scheduled for major elective surgery each year.

Read the detailed description

Background: Frail Veterans are at increased risk for poor surgical outcomes. Although surgical techniques have advanced to a level where surgery on very old adults is feasible, if a patient is also frail, the stress of surgery may overwhelm their adaptive capacities, placing them at increased risk of mortality, morbidity, and institutionalization even if surgery is technically successful. Frailty is a clinical syndrome that is commonly characterized by muscle atrophy, diminished strength and speed, decreased physical activity, and exhaustion. It is independent of any specific disease, but it increases with age and worsens disease prognoses by diminishing capacity to tolerate stressors. Thus, while surgery is often indicated for older patients, frail candidates are less likely than robust counterparts to tolerate the procedure and/or recover functional capacity. In fact, recent VA data demonstrate that frailty is a more powerful predictor of increased perioperative mortality, morbidity, length of stay, and cost than predictions based on age or comorbidity alone. As the Veteran and US populations grow older, frailty will increase, making it critically important to identify effective strategies for improving the surgical recovery and outcomes of frail patients.

"Prehabilitation" has the potential to improve surgical outcomes among the frail. Prior research demonstrates that inter-disciplinary rehabilitation strategies deployed after surgery enhance recovery and improve outcomes by building strength and improving nutrition. Based on this success, there is growing interest in "prehabilitation", which is a similar intervention deployed before surgery. By modifying physiological and environmental risks, prehabilitation aims to augment patients' capacity to compensate for the stress of surgery itself and the convalescent period thereafter. Frail patients may benefit disproportionately from prehabilitation because they have diminished capacity to endure the procedure and/or recovery. Preliminary evidence suggests that preoperative exercise interventions improve surgical outcomes. However, prehabilitation has not yet been studied in either Veteran or specifically frail populations, and no prior studies used home-based prehabilitation strategies to safely minimize travel-related barriers to participation.

Objectives: The investigators will examine the feasibility of a novel, multifaceted, home-based prehabilitation intervention designed to improve functional capacity and postoperative outcomes for frail Veterans anticipating cardiothoracic surgery. Specific aims are to:

  1. Estimate rates of recruitment, retention, and adherence to the intervention; and evaluate participation barriers.
  2. Measure changes over time in frailty, physical function, pulmonary function, nutrition, and health-related quality of life at baseline, the day of surgery, and 30 and 90 days after surgery.
  3. Explore changes in postoperative mortality, major complications, length of hospital stay, and level of independent living using case-matched historical controls.

Methods: This single-arm pilot study will enroll a consecutive cohort of up to 50 Veterans identified as frail using a standardized frailty assessment and scheduled for major cardiothoracic surgery at the VA Pittsburgh Healthcare System. The 4 week long prehabilitation regimen will include: (a) aerobic conditioning, (b) strength and coordination training, (c) respiratory muscle training, and (d) nutritional coaching and supplementation. Pre- and post-prehabilitation assessments will include: (a) frailty; (b) physical function; (c) pulmonary function; (d) nutrition; and (e) health-related quality of life. Postoperative outcomes will include length of stay, mortality and complications. Compliance with the prehabilitation regimen will be assessed through patient logs and pedometers. Analyses will inform a larger randomized controlled trial testing the prehabilitation intervention. Findings will be relevant for the 42,000 frail Veterans scheduled for major elective surgery each year.

Being tested
Prehabilitation
Keywords
Frailty, Prehabilitation, Exercise therapy, Surgery, Nutrition support
Medical subject headings
Frailty

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • PrehabilitationOther

    Prehabilitation will last 4 weeks and consist of a novel, home-based regimen of (a) aerobic conditioning; (b) strength and coordination training; (c) respiratory muscle training; and (d) nutritional coaching and supplementation.

Study groups in NCT03299101
Study groupRoleWhat they receive
PrehabilitationExperimentalProspective sample of patients anticipating cardiothoracic surgery.
Receives: Other: Prehabilitation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Recruitment Rate

    Recruitment will be expressed as the percentage of eligible patients approached who agree to participate in this pilot study.

    Measured: Baseline

  2. Retention Rate

    Retention rate will be expressed as the percentage of enrolled patients who were retained in the study and completed study procedures. It will be calculated for incremental steps along the study timeline and at the completion of study procedures 90 days postoperatively.

    Measured: 90 days postoperatively

  3. Adherence Rate

    Compliance rates will be expressed as the percentage of assigned activities actually completed by patients as recorded in home exercise and nutrition logs.

    Measured: Day of surgery

Secondary outcomes (14)
  1. Change in Grip Strength Over the Course of Treatment and Recovery.

    Grip strength will be measured in kilograms of pressure using a Smedley grip dynamometer

    Measured: Baseline, day of surgery, 90 days postoperatively

  2. Change in Pulmonary Function Over the Course of Treatment and Recovery: Max MIP

    Pulmonary function will be measured in terms of maximum MIP (maximal inspiratory pressure).

    Measured: Baseline, day of surgery, 90 days postoperatively

  3. Change in Pulmonary Function Over the Course of Treatment and Recovery: Mean MIP

    Pulmonary function will be measured in terms of mean maximal inspiratory pressure (MIP).

    Measured: Baseline, day of surgery, 90 days postoperatively

  4. Change in Pulmonary Function Over the Course of Treatment and Recovery: Max MEP

    Pulmonary function will be measured in terms of maximum MEP (maximal expiratory pressures)

    Measured: Baseline, day of surgery, 90 days postoperatively

  5. Change in Pulmonary Function Over the Course of Treatment and Recovery: Mean MEP

    Pulmonary function will be measured in terms of mean maximal expiratory pressures (MEP).

    Measured: Baseline, day of surgery, 90 days postoperatively

  6. Change in Pulmonary Function Over the Course of Treatment and Recovery: Max SMIP

    Pulmonary function will be measured in terms of maximum sustained MIP (SMIP).

    Measured: Baseline, day of surgery, 90 days postoperatively

  7. Change in Pulmonary Function Over the Course of Treatment and Recovery: Mean SMIP

    Pulmonary function will be measured in terms of mean sustained MIP (SMIP).

    Measured: Baseline, day of surgery, 90 days postoperatively

  8. Serum Prealbumin Over the Course of Treatment and Recovery

    Higher levels indicate greater levels of protein. Lower levels indicate the potential of inflammation. normal range is 18-41, Below 18 is lower than normal, above 41 is higher than normal

    Measured: Baseline, day of surgery, 90 days postoperatively

  9. Change in Gait Speed Over the Course of Treatment and Recovery

    Gait speed will be measured by using a stopwatch to time how long the patient takes to walk 4 meters

    Measured: Baseline, day of surgery, 90 days postoperatively

  10. Change in Short Physical Performance Battery (SPPB) Over the Course of Treatment and Recovery

    This standardized outcome measure asks patients to complete several activities that are scored independently and then aggregated into an overall score ranging from 0-12. Higher scores indicate better physical performance.

    Measured: Baseline, day of surgery, 90 days postoperatively

  11. Change in Risk Analysis Index of Frailty (RAI) Over the Course of Treatment and Recovery

    This recently published frailty index is assessed by a clinician administered questionnaire. The score and reflects frailty-associated mortality risk ranging from 0-81. Higher scores indicate higher risk for post operative complications and other frailty-related outcomes.

    Measured: Baseline, day of surgery, 90 days postoperatively

  12. Change in 7-point Subjective Global Assessment (SGA) of Nutrition Over the Course of Treatment and Recovery

    This standardized survey instrument is completed by a trained clinician after assessing a nutrition-specific patient history. The minimum score is 1 and the maximum score is 7. High scores indicate better nourishment.

    Measured: Baseline, day of surgery, 90 days postoperatively

  13. Change in 6 Minute Walk Test Over the Course of Treatment and Recovery

    This standardized approach measures the distance in meters walked during 6 minutes.

    Measured: Baseline, day of surgery, 90 days postoperatively

  14. Change in Health Related Quality of Life Over the Course of Treatment and Recovery

    Assessment of Quality of Life (AQoL-6D) survey. Scores range from 0 to 1. The higher the score, the better the quality of life.

    Measured: Baseline, day of surgery, 30-days postoperatively, 90-days postoperatively

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Oct 2017
  2. Study start22 Nov 2017
  3. Primary completion30 Apr 2020
  4. Study completion30 Sep 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Not applicable
Intervention model
Single group
Model description
A novel a novel, multifaceted, home-based prehabilitation intervention designed to improve functional capacity and postoperative outcomes for frail Veterans anticipating cardiothoracic surgery. Prehabilitation will include: (a) aerobic conditioning; (b) strength and coordination training; (c) respiratory muscle training; and (d) nutritional coaching and supplementation.
Masking
None (open label)
Enrolment
35 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03299101
Sponsor's protocol ID
E2562-P
Other IDs
I21RX002562
Status last verified
Dec 2020
First submitted
18 Sep 2017
Last updated
13 Jan 2021
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Prehabilitation in people with Coronary Artery Bypass Graft and Non-cardiac Thoracic Surgery, run by VA Office of Research and Development at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 13 Jan 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 21 Dec 2020). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Recruitment Rate (time frame: Baseline). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Jan 2021.

Free account

Keep searching with a free account

You’ve used your 3 free searches for this session. Log in or create a free AzTrials account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in