Search

Background Preoperative physical fitness is predictive of postoperative outcome. Patients with lesser aerobic capacity are at greater risk of postoperative complications, longer hospital stays, and mortality. Prehabilitation may improve physical fitness, but it is unknown whether enhanced fitness translates to an improvement in postoperative outcome. Methods This systematic review and meta-analysis aimed to assess the ability of prehabilitation to influence postoperative outcome after intra-abdominal operations. Randomized controlled trials with at least 1 group undergoing a preoperative exercise intervention/prehabilitation were included. The following databases were searched: AMED, CINAHL, EMBASE, PubMed/Medline, and The Cochrane Library. Data extracted from 9 full-articles included author(s), population demographics, type of operation, postoperative measures of outcome, and type of treatment of the prehabilitation and control groups. Methodologic quality was assessed using GRADEpro, and the Cochrane risk of bias tool was used to measure study bias. Results Prehabilitation consisting of inspiratory muscle training, aerobic exercise, and/or resistance training can decrease all types of postoperative complications after intra-abdominal operations (odds ratio: 0.59, 95% confidence interval: 0.38–0.91, P = .03). It is unclear from our meta-analysis whether prehabilitation can decrease postoperative length of stay, because the number of studies that examined length of stay was small ( n = 4). No postoperative mortality was reported in any study, and conclusions could not be drawn on the ability of exercise to influence operative mortality. The methodologic quality of studies was, however, “very low.” Conclusion Prehabilitation appears to be beneficial in decreasing the incidence of postoperative complications; however, more high-quality studies are needed to validate its use in the preoperative setting. [ABSTRACT FROM AUTHOR]

Objective This systematic review and meta-analysis aimed to identify the modifiable determinants of adjuvant hormonal therapy medication taking behaviour (MTB) in women with stage I-III breast cancer in clinical practice settings. Methods We searched PubMed EMBASE, PsycINFO and CINAHL for articles investigating determinants of adjuvant hormonal therapy. Potentially modifiable determinants were identified and mapped to the 14 domains of the Theoretical Domains Framework (TDF), an integrative framework of theories of behavioural change. Meta-analysis was used to calculate pooled odds ratios for selected determinants. Results Potentially modifiable determinants were identified in 42 studies and mapped to 9 TDF domains. In meta-analysis treatment side-effects (Domain: Beliefs about Capabilities ) and follow-up care with a general practitioner (vs. oncologist) (S ocial Influence s) were significantly negatively associated with persistence ( p < 0.001) and number of medications ( Behaviour Regulation ) was significantly positively associated with persistence ( p < 0.003) . Studies did not examine several domains (including Beliefs about Consequences , Intentions , Goals , Social Identity , Emotion and Knowledge ) which have been reported to influence MTB in other disease groups. Conclusions There is some evidence that the domains Beliefs about Capabilities , Behaviour Regulation and Social Influences influence hormonal therapy MTB. Practice implications Further research is needed to develop effective interventions to improve hormonal therapy MTB. [ABSTRACT FROM AUTHOR]

Emerging evidence supports exercise as a therapeutic intervention for patients with bone metastases. However, exercise prescription in practice is limited by concerns regarding skeletal-related events (SREs). This study examined associations among habitual physical activity levels, history of SREs, and patient reported outcomes in patients with bone metastases. A total of 58 patients with bone metastases (n = 45 breast cancer; n = 13 prostate cancer; mean time since cancer diagnosis 5.8 [4.7] years) were assessed. Habitual physical activity levels were collected by accelerometry. Standardized subjective assessment collected history of SREs, quality of life (EORTC-QLQ-C30 and EORTC-BM22), pain (Brief Pain Inventory), sleep quality (Pittsburgh Sleep Quality Questionnaire), and perceptions about exercise (Exercise Benefits/Barriers Scale). Participants spent a mean of 77.37% (standard deviation 14.3)% of waking hours sedentary and a mean of 20.14% (standard deviation 13.4)% of waking hours in light intensity activity. Almost half (n = 28) completed ≥150 min/wk moderate-to-vigorous intensity activity. Higher levels of moderate-to-vigorous intensity activity were associated with lower pain scores, better perceived physical function, lower functional interference scores, and better quality of life. Patients with a history of fracture since diagnosis spent more time sedentary and in light intensity activity in comparison to those with no fracture history (P <.05). Moderate-to-vigorous intensity physical activity may have multiple benefits for patients with bone metastases. Reducing sedentary behavior may be a key target for patients with a history of fracture. Oncology nurses play a key role in providing education on the benefits of exercise, overcoming barriers to physical activity and timely referrals. [ABSTRACT FROM AUTHOR]

Study Objective: To assess the ability of field tests of exercise tolerance, such as the 6-minute walk test (6MWT) and incremental shuttle walk test (ISWT), to predict postoperative outcome following intra-abdominal surgery.Design: A systematic review.Setting: A hospital-affiliated university.Measurements: The following databases were searched: AMED, CINAHL, EMBASE, PEDro, PubMed/MEDLINE, and The Cochrane Library. Six full-text articles were included. Data extraction included author, population demographics, surgery type, postoperative outcome measure, and field test results. The risk of bias was performed using the Quality in Prognosis Studies tool.Results: Surgical procedures reviewed were colorectal (n=3), upper gastrointestinal (n=1), and intra-abdominal surgery (n=2). Field tests of exercise tolerance showed little ability to predict postoperative mortality; however, the overall rate of mortality was low. Patients achieving lower distances on the ISWT tended to have longer hospital stays and an increased risk of overall complications. The 6MWT does not appear able to predict postoperative cardiac or pulmonary complications; however, it may be suitable to predict general complications.Conclusions: Field tests may be able to predict postoperative outcome; however, further validation is needed. The ISWT appears to be the superior field test. The 6MWT and stair climb test require further validation to assess their predictive ability. [ABSTRACT FROM AUTHOR]

Crutches are commonly prescribed to patients with lower limb dysfunction during rehabilitation to assist with mobility. The aim of this study was to determine the energy expenditure for non-weight bearing crutch walking on level ground and ascending stairs at a self selected speed in a healthy adult population. Thirty-one healthy male and female adults (mean ± SD: age 21.6 ± 1.2 years; height 170.8 ± 10.8 cm; weight 70.8 ± 11.4 kg) mobilised non-weight bearing with elbow crutches along a 30 m corridor and (with one crutch) up a flight of 13 stairs. Energy expenditure for each activity was measured by indirect calorimetry using the COSMED K4b 2 portable ergospirometry system. The established VO 2 values were 16.4 ml/kg/min for crutch walking on level ground and 17.85 ml/kg/min for stair climbing. Non-weight bearing crutch walking at a self selected speed on the level ground and up a flight of stairs resulted in a MET value of 4.57 and 5.06 respectively. The mean heart rate (HR) for crutch walking along the flat was 117.06 ± 20.54 beats per minute (bpm), while the mean HR for ambulating upstairs with crutches was 113.91 ± 19.32 bpm. The increased energy demands of non-weight bearing crutch walking should be considered by physical therapists when instructing patients on crutch use. Further investigation to determine the implications of these results in populations with chronic disease is warranted. [ABSTRACT FROM AUTHOR]