Prehabilitation - Enhanced Recovery After Colorectal Surgery

Study Overview
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Brief Summary
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The purpose of this study is to determine whether a combined cardiorespiratory and strengthening training prior to colorectal surgery decreases the rate of surgery-related complications.

Detailed Description
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This single site study investigates whether a preoperative training reduces the number and severity of perioperative complications in patients undergoing elective colorectal surgery according to the Enhanced Recovery After Surgery (ERAS) pathway. The study will be approved by a local ethical committee and conducted in compliance with the protocol, the current version of the Declaration of Helsinki, the ICH-GCP as well as all national legal and regulatory requirements. Before inclusion informed written consent will be obtained from all patients. Once the indication for the surgical intervention is given patients may be included into the study. Patients of the experimental group will be provided with a tailored training program aiming at maximally improving physical fitness in order to withstand the surgical stress. Depending on the urgency of the operation this training program will last between two and six weeks. Three weekly trainings are foreseen of which two will be performed in a setting supervised by a physiotherapist and one at the patient's home. Patients assigned to the control group receive the usual care i.e. information about the upcoming procedure and the advice to remain physically active. From the point of the operation both groups will be treated equally. Outcome measures will be obtained from the inclusion into the study up to one month after surgery.

Official Title
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Randomized Controlled Trial Assessing the Value of Prehabilitation in Patients Undergoing Colorectal Surgery According to the ERAS Protocol for the Improvement of Postoperative Outcomes

Conditions
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Surgical Operation With Reversal of External Stoma, Colorectal Surgery

Intervention / Treatment
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* Other: Cardiorespiratory and resistance training.
* Other: Reference


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients (age ≥ 18 years) suffering from colorectal diseases needing an operative treatment and treated along our ERAS pathway Patients suffering from colorectal cancer, diverticulosis, benign tumors such as polyps or inflammatory bowel disease and surgically treated (i.e. rectosigmoid resection, anterior resection of rectum, ileocaecal/right hemicolectomy, left hemicolectomy, abdominoperineal resection or total/subtotal colectomy), and patients undergoing reversal of Stoma and Hartmann procedures will be included. Informed Consent as documented by signature Exclusion Criteria: Patients suffering from severe dementia or other cognitive impairment, what hinders them to give informed consent Patients with a physical impairment, who can't perform the necessary physical Training Patients, who are not able or willing to attend the physical training at the institute of physiotherapy of the Kantonsspital Winterthur Inability of the participant to follow the procedures of the study, e.g. due to language problems, psychological disorders, etc. Participation in another study with investigational drug within the 30 days preceding and during the present study Enrolment of the investigator, his/her family members, employees and other dependent persons

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Prehabilitation<br>'Cardiorespiratory and resistance training. | Other: Cardiorespiratory and resistance training.<br>* A cardiorespiratory and resistance training program for at least 2 to 3 weeks will be conducted 3-times per week, of which two sessions will be supervised by a qualified person of the institute of physiotherapy and one session will be unsupervised and home-based. Physiotherapy consists of one hour, moderate to intense interval training combined with muscle strength training.<br>|
| Active Comparator: Reference<br>Usual care. | Other: Reference<br>* No preoperative physical therapy training. Patients will be informed to remain physically active (as usual) until surgery.<br>* Other names: Usual care.;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comprehensive Complication Index (CCI) | ssessment of patients' overall morbidity. CCI is based on the complication grading by Clavien-Dindo Classification and implements every occurred complication after an intervention. The overall morbidity is reflected on a scale from 0 (no complication) to 100 (death). | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clavien/Dindo | Assessment of post-surgical complications, ranging from Grade I (any deviation from normal postoperative Course) to Grade V (death of Patient). | 30 days | 
| Five Times Sit to Stand Test | Time needed to raise from and sit-down on a chair for five times. | 30 days | 
| 2-Minute Walk Test | Distance covered within two minutes of brisk walking. | 30 days | 
| Perceived pain | Numeric rating scale ranging from Zero (no pain) to ten (worst pain). | 30 days |