Mentored multimodal prehabilitation for aortic aneurysm surgery: a pilot randomised controlled trial

Area of Science:

• Perioperative Medicine
• Surgical Oncology
• Rehabilitation Medicine

Background:

• Prehabilitation before surgery is increasingly recognized for improving patient outcomes.
• Multimodal prehabilitation, including exercise and lifestyle changes, is a key area of perioperative care research.
• Investigating the logistical feasibility of prehabilitation trials is crucial for implementation.

Purpose of the Study:

• To assess the feasibility of recruiting, retaining, and ensuring adherence to a multimodal prehabilitation program for patients undergoing aortic aneurysm repair.
• To explore secondary patient outcomes such as functional status, quality of life, and postoperative complications.
• To inform the design of a full-scale randomized controlled trial.

Main Methods:

• A feasibility, assessor-blinded, parallel-group, randomized controlled trial was conducted.
• Participants were randomized into control, non-mentored prehabilitation, or mentored prehabilitation groups.
• Primary feasibility outcomes included recruitment rates, retention to follow-up, adherence to interventions (activity trackers, workshop attendance), and blinding maintenance.

Main Results:

• Screening and recruitment feasibility were achieved, with 75% of screened patients enrolled.
• Participant retention was high (93%), but adherence to activity tracker use was lower than targeted (53.5%) due to device issues.
• No significant increase in physical activity levels was observed in the prehabilitation groups compared to the control group.

Conclusions:

• The study met primary feasibility targets for recruitment, retention, and follow-up completion.
• Adherence to activity monitoring was suboptimal, and the targeted increase in physical activity was not achieved.
• A full randomized controlled trial is feasible but requires modifications to the prehabilitation intervention and study design.