Pragmatic Prehabilitation for Colorectal Surgery

Study Overview
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Brief Summary
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Colorectal surgery is a common surgery for the treatment of colon and rectal cancers as well as other bowel diseases. Recovery from colorectal surgery is difficult because of the many potential negative side effects. These side effects include surgical complications, infections, and long hospital stays. It usually takes several months for patients to recover the strength required to return to their typical daily activities. The Enhanced Recovery After Surgery program was established in Alberta in 2013 and uses several strategies to improve short-term patient recovery, including earlier discharge from hospital. Whether the ERAS program also improves long-term patient recovery, including quality of life and return to activities of daily living, is unclear. Whether the ERAS program would benefit from the addition of a prehabilitation element is unclear. Prehabilitation programs are designed to use the waiting period before colorectal surgery to better prepare patients emotionally and physically for their operation. To date, successful prehabilitation programs have used a personalized care strategy where each patient is provided specific care instructions by healthcare professionals to meet their unique exercise, nutrition, and psychological needs. This prehabilitation strategy has been criticized for not being sustainable in our healthcare system. A new prehabilitation program in response to this criticism is proposed. The prehabilitation program will be conducted in a more sustainable way by offering the program as a group class with a home-based component. ERAS patients at the Peter Lougheed Center are already offered a group class as part of the standard ERAS program. The prehabilitation class will be an extension of this group class that provides general nutrition, exercise, and anxiety-reduction/relaxation strategies to help patients prepare physically and emotionally for their operation. At this class, patients will learn to eat well, practice deep breathing exercises for relaxation, perform simple functional exercises, and to walk for exercise before their surgery. The surgical experience and outcomes of patients who received the additional prehabilitation care will be compared to those who received ERAS care only. The overall goal of the study is to better understand how ERAS supports recovery after surgery and whether a prehabilitation program offers any additional benefits to the ERAS program currently in place.

Official Title
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Prehabilitation for Colorectal Surgery: A Pragmatic Effectiveness-Implementation Randomized Controlled Trial

Conditions
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Prehabilitation, Colorectal Surgery, Enhanced Recovery After Surgery

Intervention / Treatment
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* Combination Product: Prehab
* Other: ERAS
* Behavioral: Fitbit


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years of age or older; elective colorectal surgery for primary disease under ERAS care at PLC; have at least two weeks to participate before their scheduled surgery (i.e., surgery will NOT be rescheduled based on participation in this program); are able to walk; sufficient fluency in English to complete questionnaires. Exclusion Criteria: emergent surgery; dairy allergy; galactosemia; strict vegans; presence of a condition that could compromise the safety of the patient or adherence to the program, including Co-morbid medical, physical, and/or mental conditions including dementia, disabling orthopedic and neuromuscular disease, psychosis; Severe cardiopulmonary abnormalities, sepsis, and end-stage organ disease: cardiac failure (New York Heart Association classes III-IV), chronic obstructive pulmonary disease, renal failure (creatinine > 115µmol/l), hepatic failure (liver aminotranferases >50% the normal range).

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Pragmatic RCT Effectiveness- Implementation Hybrid
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Prehab<br>General nutrition, relaxation, and exercise instructions. Home-based functional exercises, Fitbit goals, and nutrition supplements. | Combination Product: Prehab<br>* Exercise: functional exercises, walking, Fitbit goals Nutrition: handout, supplements (protein, vitamins, minerals) Stress reduction: deep breathing<br>Other: ERAS<br>* Enhanced Recovery After Surgery guidelines are applied.<br>Behavioral: Fitbit<br>* Fitbit is worn to monitor step counts.<br>|
| Active Comparator: ERAS<br>Enhanced Recovery After Surgery standard of care plus Fitbit. | Other: ERAS<br>* Enhanced Recovery After Surgery guidelines are applied.<br>Behavioral: Fitbit<br>* Fitbit is worn to monitor step counts.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length of stay (LOS) | Length of hospital stay | from date of surgery until hospital discharge, recorded in days, and assessed up to 6 weeks post-surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Complications | Any complication within 30 days of surgery | from date of surgery until 30 days post-surgery |