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Inguinal HerniaNCT05069142

Peri-Operative Rehab Program for Inguinal Hernia Repair Surgery

A study testing Rehabilitation in people with Inguinal Hernia, run by University of Alberta at 1 site in Canada.

Completed

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

Official record
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Trial summary

Inguinal hernia repair is one of the most common surgeries, with more than 20 million performed globally each year. It is estimated that approximately 15% of patients undergoing inguinal hernia repair will experience persistent post-surgical pain that could last months to years. Read more about this study

Who is it for?
Ages 18 to 99 years
Conditions the study is for
Inguinal Hernia
What is being tested?
Rehabilitation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
31 participants
Where
1 siteCanada
Study dates
1 Jan 2022to 9 Jun 2023
Phase
Interventional
Are there results?
None posted in the registry

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 18 to 99 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Scheduled to undergo first-time inguinal hernia repair surgery after a physical examination identified signs and symptoms consistent with inguinal hernia (direct or indirect hernia)
  • Willingness to participate in a targeted peri-operative exercise program
  • 18+ years of age
  • No medical contraindications to participation in exercise
  • Employed full-time and required to lift at least 10kg for work

Who cannot join

  • Previous inguinal hernia
  • Body Mass Index >35 since morbidly obese patients experience more surgical complications
  • Specific contra-indications that will be screened for include associated medical conditions that preclude exercise, this includes uncontrolled medical conditions including diabetes, hypertension, vertigo, congestive heart failure, chronic obstructive pulmonary disease, intra-abdominal ascites, or pre-existing malnutrition. We will also screen for use or narcotics, bone and joint conditions of the spine or extremities, or history of other abdominal surgeries.

Trial locations and contacts

1 site in 1 country.

Canada1 site
  • Fort Saskatchewan Community Hospital

    Ft Saskatchewan, Alberta

Other trials in Canada

About this study

Official title: A Study Evaluating the Feasibility of a Peri-Operative Rehabilitation Program for Inguinal Hernia Repair Surgery to Reduce Risk of Post-Surgical Pain

Inguinal hernia repair is one of the most common surgeries, with more than 20 million performed globally each year. It is estimated that approximately 15% of patients undergoing inguinal hernia repair will experience persistent post-surgical pain that could last months to years. Evidence from related procedures indicates that better surgical preparation through pre-operative exercise and education (i.e. Prehabilitation) followed by ongoing post-surgical rehabilitation leads to more rapid recovery, return to activities and lower likelihood of persistent post-surgical pain. The investigators will determine the feasibility of a peri-operative rehabilitation program (pre- and post-surgery) and our study protocol for patients undergoing inguinal hernia repair surgery. The investigators hypothesize that: 1) our peri-operative intervention will be feasible and safe to undertake within a clinical setting; 2) adequate numbers will be enrolled to justify a larger trial; and that 3) our outcome measurement protocol will provide meaningful information with high response rate and low attrition after 3 months.

Read the detailed description

Inguinal hernia repair is one of the most common surgeries performed globally, with more than 20 million performed each year. Not only does this huge number of surgeries have a substantial direct economic burden on healthcare systems, there is also indirect impact from time off work and decreased productivity due ongoing post-surgical pain requiring extended time spent on modified duties. It is estimated that approximately 15% of patients undergoing inguinal hernia repair will experience persistent post-surgical pain that could last months to years. Furthermore, current clinical guidelines for return to work and activity after inguinal hernia repair are inconsistently informed by evidence, highly variable, and outdated. Forbes et al (2012) found that the average patient undergoing inguinal hernia repair experiences more than 40 days of short-term disability despite indications that earlier return to activity is safe (i.e. will not lead to repair failure) and likely beneficial for reducing chronic pain and disability.

Evidence from related procedures indicates that better surgical preparation through pre-operative exercise and education (i.e. Prehabilitation) followed by ongoing post-surgical rehabilitation leads to more rapid recovery, return to activities and lower likelihood of persistent post-surgical pain. Prehabilitation was first described in the 1940's when the British Army developed a prehabilitation program as part of an experiment to increase the quality of recruits. The concept of prehabilitation gained traction within the medical community when Topp et. al. and Ditmyer et. al. promoted a theoretical model of prehabilitation, positing that patients who participate in presurgical exercise with the goal of improving functional capacity may experience more rapid postoperative recovery than patients who remain physically inactive through the preoperative period. Prehab has also been shown to increase self-efficacy, a moderator of pain catastrophizing and fear avoidance beliefs, that are important factors linked to the pain experience of those with persistent pain. The investigators propose that this theoretical model can be extrapolated to inguinal hernia repair and theorize that prehabilitation will increase patients' preoperative self-efficacy, allowing them to more rapidly regain abilities, subsequently shortening duration of modified duties and decreasing likelihood of persistent post-surgical pain.

Little information is available regarding the use of prehabilitation in the context of inguinal hernia repair. There have been numerous studies looking at prehabilitation in orthopedics, cardiovascular surgery, and prior to major abdominal surgeries, but limited studies for inguinal hernia repair. A randomized control study by Liang et. al. examined the impact of prehabilitation on ventral hernia recurrence and post-operative complications. They concluded that patients undergoing prehabilitation have a higher likelihood of being hernia-free and complication-free 30 days postoperatively. Notably, this study is limited in that only obese patients were included, and outcomes only included recurrence and complications. No studies were located examining the impact of prehabilitation on recovery time, post-surgical pain, and return to activity after inguinal hernia repair. However psychosocial factors such as pain catastrophizing appear to be important predictors. Typical practice guidelines often recommend limiting activity for at least 3 months to avoid re-rupture. However, these guidelines are based on expert opinion due to a lack of quality research and can pose a risk in building unhelpful beliefs about pain, fear of movement and poor coping strategies. Research is needed to inform practice guidelines and return-to-activity recommendations.

Conditions
Inguinal Hernia
Being tested
Rehabilitation
Keywords
rehabilitation, prehabilitation
Medical subject headings
Hernia, Inguinal

What participants receive

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

  • RehabilitationOther

    Pre- and post-operative exercise and education.

Study groups in NCT05069142
Study groupRoleWhat they receive
Intervention groupExperimental15 participants will be randomly selected to the intervention group. These individuals will receive six weeks of pre-operative exercise instruction and education, as well as six weeks of graduated post-operative exercise instruction, beginning at three weeks post-op with the surgeons clearance.
Receives: Other: Rehabilitation
Control groupNo intervention15 participants will be randomly selected to the control group. This group will receive pre-operative education in the form of videos regarding the procedure and pain. They will not receive exercise instruction.

What is being measured

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

  1. Visual Analogue Pain Scale

    Post-surgical pain intensity ratings will be measured on a 0-100mm Visual Analogue Scale, a valid measure of pain intensity.

    Measured: 3 Months after the operation

Secondary outcomes (2)
  1. Carolinas Comfort Scale (CCS)

    Post-surgical pain quality will be measured using the Carolinas Comfort Scale (CCS), a questionnaire for evaluating pain and sensations experienced by patients after inguinal hernia operations.

    Measured: 3 Months after the operation

  2. Change in scores on the Short-Form Functional Capacity Evaluation

    The Short-Form Functional Capacity Evaluation is a performance-based test of work function. In this test, patients are tested on 5 key activities of work performance (lifting, standing, trunk rotation, crouching, forward trunk flexion). Performance on each scale is compared to required job demands and the number of "failed" items is summed (0 to 5 failures). Short-Form Functional Capacity Evaluation is a valid indicator of work ability that has been found predictive of future work ability.

    Measured: Changes between baseline to three months after the operation.

Timeline

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

  1. First posted6 Oct 2021
  2. Study start1 Jan 2022
  3. Primary completion12 Oct 2022
  4. Study completion9 Jun 2023

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
Randomised
Intervention model
Parallel groups
Model description
Pilot Parallel-Group Randomized Controlled Trial
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
31 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05069142
Sponsor's protocol ID
Pro00106451
Status last verified
Oct 2023
First submitted
22 Sep 2021
Last updated
23 Oct 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Since this is a pilot study we have no plans to share IPD with other researchers

Publications

  • HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018 Feb;22(1):1-165. doi: 10.1007/s10029-017-1668-x. Epub 2018 Jan 12.

    PubMed 29330835
  • van Hanswijck de Jonge P, Lloyd A, Horsfall L, Tan R, O'Dwyer PJ. The measurement of chronic pain and health-related quality of life following inguinal hernia repair: a review of the literature. Hernia. 2008 Dec;12(6):561-9. doi: 10.1007/s10029-008-0412-y. Epub 2008 Aug 21.

    PubMed 18716856
  • Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA. A review of chronic pain after inguinal herniorrhaphy. Clin J Pain. 2003 Jan-Feb;19(1):48-54. doi: 10.1097/00002508-200301000-00006.

    PubMed 12514456
  • Cabilan CJ, Hines S, Munday J. The effectiveness of prehabilitation or preoperative exercise for surgical patients: a systematic review. JBI Database System Rev Implement Rep. 2015 Jan;13(1):146-87. doi: 10.11124/jbisrir-2015-1885.

    PubMed 26447015
  • Lundberg M, Archer KR, Larsson C, Rydwik E. Prehabilitation: The Emperor's New Clothes or a New Arena for Physical Therapists? Phys Ther. 2019 Feb 1;99(2):127-130. doi: 10.1093/ptj/pzy133. No abstract available.

    PubMed 30508203
  • Topp R, Ditmyer M, King K, Doherty K, Hornyak J 3rd. The effect of bed rest and potential of prehabilitation on patients in the intensive care unit. AACN Clin Issues. 2002 May;13(2):263-76. doi: 10.1097/00044067-200205000-00011.

    PubMed 12011598
  • Ditmyer MM, Topp R, Pifer M. Prehabilitation in preparation for orthopaedic surgery. Orthop Nurs. 2002 Sep-Oct;21(5):43-51; quiz 52-4. doi: 10.1097/00006416-200209000-00008.

    PubMed 12432699
  • Liang MK, Bernardi K, Holihan JL, Cherla DV, Escamilla R, Lew DF, Berger DH, Ko TC, Kao LS. Modifying Risks in Ventral Hernia Patients With Prehabilitation: A Randomized Controlled Trial. Ann Surg. 2018 Oct;268(4):674-680. doi: 10.1097/SLA.0000000000002961.

    PubMed 30048306
  • Nienhuijs SW, Rosman C, Strobbe LJ, Wolff A, Bleichrodt RP. An overview of the features influencing pain after inguinal hernia repair. Int J Surg. 2008 Aug;6(4):351-6. doi: 10.1016/j.ijsu.2008.02.005. Epub 2008 Mar 4.

    PubMed 18450528
  • Sobol-Kwapinska M, Babel P, Plotek W, Stelcer B. Psychological correlates of acute postsurgical pain: A systematic review and meta-analysis. Eur J Pain. 2016 Nov;20(10):1573-1586. doi: 10.1002/ejp.886. Epub 2016 May 2.

    PubMed 27136510
  • Schug SA, Lavand'homme P, Barke A, Korwisi B, Rief W, Treede RD; IASP Taskforce for the Classification of Chronic Pain. The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain. Pain. 2019 Jan;160(1):45-52. doi: 10.1097/j.pain.0000000000001413.

    PubMed 30586070
  • Yeo AE, Berney CR. Carolinas Comfort Scale for mesh repair of inguinal hernia. ANZ J Surg. 2012 Apr;82(4):285-6. doi: 10.1111/j.1445-2197.2012.06012.x. No abstract available.

    PubMed 22510195
  • Heniford BT, Lincourt AE, Walters AL, Colavita PD, Belyansky I, Kercher KW, Sing RF, Augenstein VA. Carolinas Comfort Scale as a Measure of Hernia Repair Quality of Life: A Reappraisal Utilizing 3788 International Patients. Ann Surg. 2018 Jan;267(1):171-176. doi: 10.1097/SLA.0000000000002027.

    PubMed 27655239
  • Shologan A, Farooq O, Bostick G, Macedo L, Durand-Moreau Q, Peters MR, Gross DP. A pilot randomized controlled trial examining the feasibility of perioperative rehabilitation for inguinal hernia repair surgery. PLoS One. 2025 May 22;20(5):e0324907. doi: 10.1371/journal.pone.0324907. eCollection 2025.

    PubMed 40403095

Questions about this trial

What is this clinical trial studying?

A study testing Rehabilitation in people with Inguinal Hernia, run by University of Alberta at 1 site in Canada.

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 5 inclusion and 3 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 23 Oct 2023. 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 Canada. 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Visual Analogue Pain Scale (time frame: 3 Months after the operation). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05069142, which also lists 14 linked publications.

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 23 Oct 2023.

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