Multifunctional Approach in Cardiac Surgery

NCT ID: NCT05824598

Last Updated: 2024-02-20

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

COMPLETED

Clinical Phase

NA

Total Enrollment

44 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-05-15

Study Completion Date

2023-12-31

Brief Summary

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Postoperative pain and swallowing disorders are complex, multifactorial phenomenon that frequently occur after cardiac surgery. Preoperative anxiety and the interaction between sex and other sociocultural factors may predict greater sensitivity to postoperative pain, whereas the epidemiology and course of swallowing disorders has not been systematically investigated, along with the interaction between dysphagia, post-operative pain and emotional stress. Cardiac rehabilitation is a multifunctional intervention which may address all these functional domains, improving patients' prognosis.

The aim of the present study is to demonstrate the superiority of a multifunctional approach (OMT, systematic swallowing screening and specific treatment according to good clinical practice associated with psychological counseling) compared to local clinical practice in the management of pain and swallowing disorders.

Detailed Description

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The TITANIC trial will provide evidence on whether a multifunctional intervention systematically implemented in the cardiac rehabilitation setting will improve the clinical course and prognosis of patients with recent cardiac surgery.

The design is a randomized clinical trial with parallel group design. Patients aged over 18 undergoing elective cardiac surgery and admitted to IRCCS Fondazione Don Gnocchi, Santa Maria Nascente, Milan, for cardiac rehabilitation will be randomized to standard post-acute treatments (cardiovascular training, monitoring and logopedic treatment only in case of swallowing dysfunction) compared with an experimental approach which consists of osteopathic manipulative treatment (OMT) treatments, swallowing screen protocol, psychological assessment and counseling.

This study may help in the identification of a new diagnostic-therapeutic pathway in cardiac surgery patients that allows a reduction in the use of analgesics and anti-inflammatories and increases the early detection of swallowing disorders. Furthermore, by allowing an integrated assessment of emotional needs, it can have a positive effect in reducing the need for post-operative clinical visits and assessments in the medium to long term, improving the patients' quality of life.

Conditions

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Heart; Surgery, Heart, Functional Disturbance as Result

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Monocentric, single blind with parallel arm design. Standard descriptive analysis and linear and logistic regression models will be performed.

To correct any imbalances between the 2 groups due to the low sample size, an analysis adjusted for the main confounders listed below is planned: age, gender, previous cognitive impairment, previous presence of anxiety and depression beyond the clinically acceptable threshold.

Sample size estimation was performed using G\*Power v3.1 software. The sample size was calculated separately for the two outcomes of interest that will make up the composite score: reduction in pain assessed using the Numerical Rating Scale (NRS) and reduction in anxiety and depression assessed using the Hospital Anxiety and Depression Scale (HADS).

It was then decided to conservatively adopt the higher number of the two estimates.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
The pain scores will be assessed by a psychologist blinded to group allocation

Study Groups

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Treatment

The cases (active treatment) will be treated with an approach that includes osteopathic treatment for pain control (by the Osteopath Bruno Bordoni), systematic swallowing screening (Speech Therapist, Leone Stilo), psychological counseling (Psychologist, Eleonora Volpato, Giulia Novembre ). The duration of treatment will be that of hospitalization, on average about 3 weeks. The osteopathic treatment will last 5 sessions, while the counseling will have one session at the admission and one at the discharge and up to two sessions a week (variable according to individual needs); the swallowing screening will have one session at the admission and one at discharge and about two-three sessions a week (variable according to individual needs).

Group Type EXPERIMENTAL

Multifunctional rehabilitation treatment

Intervention Type BEHAVIORAL

multidisciplinary approach with (OMT, psychological counseling, and therapists dedicated to swallowing disorders)

Controls

Controls will follow good clinical practice (in this case systematic screening from a swallowing point of view will not be applied, nor will osteopathic treatment and systematic psychological counseling be considered).

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Multifunctional rehabilitation treatment

multidisciplinary approach with (OMT, psychological counseling, and therapists dedicated to swallowing disorders)

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* patients with recent cardiac surgery (within one month)
* without swallowing disorders already identified before discharge
* with the presence of chest pain (NRS\>2).

Exclusion Criteria

* patients who are unable to sign informed consent.
* patients with already known psychological/psychiatric disorders.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fondazione Don Carlo Gnocchi Onlus

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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IRCCS Fondazione Don Gnocchi, ONLUS

Milan, , Italy

Site Status

Countries

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Italy

Other Identifiers

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06_08/02/2023

Identifier Type: -

Identifier Source: org_study_id

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