Trimodal Prehabilitation for Cystectomy Patients to Enhance Post-operative Care

NCT ID: NCT03347045

Last Updated: 2017-11-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-01-15

Study Completion Date

2019-07-15

Brief Summary

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Trimodal prehabilitation is a preoperative three-tiered (trimodal) approach to optimizing physical and mental health. It has been found to successfully improve functional recovery in patients undergoing colorectal surgery following an evidence-based enhanced-recovery pathway (ERP). It is unknown whether the same program is effective in patients undergoing a similar surgery for bladder cancer (radical cystectomy).

Objective: To evaluate the appropriateness of a standardized prehabilitation program for implementation into an enhanced recovery pathway for cystectomy patients and determine whether prehabilitation facilitates earlier recovery of functional capacity.

Hypothesis: Prehabilitation will ultimately improve recovery of functional capacity, clinical and patient-centered outcomes in patients undergoing radical cystectomy for bladder cancer.

Design: Participants will follow an 8-week trimodal prehabilitation program consisting of exercise therapy combined with nutritional counseling, protein supplementation, and psychological care; they will be compared to a cohort of participants following ERP care alone.

Conclusion: The proposal will provide insight into the feasibility and effectiveness of trimodal prehabilitation for radical cystectomy patients and may ultimately lead to improved clinical outcomes and reduced morbidity.

Detailed Description

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Conditions

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Bladder Cancer Nutrition Aspect of Cancer

Keywords

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cystectomy nutrition physiotherapy prehabilitation enhanced recovery after surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Single-center pragmatic randomized-control trial.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Assessor blinding; due to the nature of the study, participant, care provider \& investigator cannot be blinded.

Study Groups

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Trimodal Prehab & ERP

Trimodal prehab includes:

1. Guided exercise program at Repsol Place in Calgary, Alberta 2x/week, hosted by the Total Cardiology group. Home-exercise program for another 3x/week.
2. Nutritional optimization with a high-protein oral supplement, along with nutritional counseling and access to a Registered Dietitian on site.
3. Anxiety reduction workshop and take-home anxiety reduction program.

Group Type EXPERIMENTAL

Trimodal Prehab & ERP

Intervention Type COMBINATION_PRODUCT

1-hr daily exercise will be completed a total of 5d/week, of which 2 of these sessions are completed through a community fitness center. Following these sessions, the participant will consume a high-protein oral supplement.

Additionally, during the program, participants will be given the option of attending a stress-reduction group and will receive a take-home anxiety-reduction program. They will have access to a physiotherapist, kinesiologist, registered dietitian, and physician throughout the program.

The total length of this program is 8-weeks and is timed to occur in the waiting period between the consent for surgery and operation date.

No Prehab; ERP Alone

The active comparator group will be given a home exercise program, nutrition education, and a take-home anxiety reduction program.

Group Type ACTIVE_COMPARATOR

No Prehab; ERP Alone

Intervention Type OTHER

1-hr daily exercise with a self-completed home-exercise program. The participant will be given nutritional education material and a take-home anxiety-reduction program. They will be responsible for maintaining a journal of their activity.

Interventions

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Trimodal Prehab & ERP

1-hr daily exercise will be completed a total of 5d/week, of which 2 of these sessions are completed through a community fitness center. Following these sessions, the participant will consume a high-protein oral supplement.

Additionally, during the program, participants will be given the option of attending a stress-reduction group and will receive a take-home anxiety-reduction program. They will have access to a physiotherapist, kinesiologist, registered dietitian, and physician throughout the program.

The total length of this program is 8-weeks and is timed to occur in the waiting period between the consent for surgery and operation date.

Intervention Type COMBINATION_PRODUCT

No Prehab; ERP Alone

1-hr daily exercise with a self-completed home-exercise program. The participant will be given nutritional education material and a take-home anxiety-reduction program. They will be responsible for maintaining a journal of their activity.

Intervention Type OTHER

Other Intervention Names

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Trimodal prehab and enhanced-recovery pathway (ERP) together No trimodal prehab; enhanced-recovery pathway (ERP) alone

Eligibility Criteria

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Inclusion Criteria

1. Male or female ≥ 18 years of age at time of consent for surgery.
2. Documentation of bladder cancer diagnosis as evidenced by diagnostic imaging and biopsy.
3. May or may not receive adjuvant therapy.
4. Written informed consent obtained from subject

Exclusion Criteria

1. Presence of a condition or abnormality that in the opinion of the investigator would compromise the safety of the patient or adherence to the program. This includes:

1. American Society of Anesthesiologists (ASA) health class status 4-5;
2. Co-morbid medical, physical, and/or mental conditions including dementia, disabling orthopedic and neuromuscular disease, psychosis;
3. Severe cardiac abnormalities, end-stage organ disease, sepsis, or morbid obesity (BMI greater than 35);
2. Undergoing radical cystectomy for a reason other than bladder cancer.
3. Poor comprehension of English or French
4. Screened by Total Cardiology staff and determined to be inappropriate for prehabilitation at their facility.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Alberta Health services

OTHER

Sponsor Role collaborator

University of Calgary

OTHER

Sponsor Role collaborator

Physiotherapy Alberta - College + Association

UNKNOWN

Sponsor Role collaborator

University of Alberta

OTHER

Sponsor Role collaborator

Jason Martyn

OTHER

Sponsor Role lead

Responsible Party

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Jason Martyn

Physiotherapist

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Jason Martyn, MScPT

Role: PRINCIPAL_INVESTIGATOR

Alberta Health services

Central Contacts

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Jason Martyn, MScPT

Role: CONTACT

Phone: 403-943-3575

Email: [email protected]

Chelsia Gillis, PhD

Role: CONTACT

Email: [email protected]

Provided Documents

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Document Type: Study Protocol

View Document

Other Identifiers

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2017CRIF-JMARTYN

Identifier Type: -

Identifier Source: org_study_id