Prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO): study protocol for a randomized, controlled, outcome assessor-blinded trial
Stefan J. Schaller, Jörn Kiselev, Verena Loidl, Wilm Quentin, Katrin Schmidt, Rudolf Mörgeli, Tanja Rombey, Reinhard Busse, Ulrich Mansmann, Claudia Spies, Claudia Spies, Ursula Marschall, Rahel Eckardt‐Felmberg, Irmgard Landgraf, Ulrich Schwantes, Reinhard Busse, Ulrich Mansmann, PRAEP-GO investigators, Friedrich Borchers, Rudolf Mörgeli, Eva Schönenberger, Philipp Klassen, Bernadette Kleikamp, Philipp Brandhorst, Anna-Lena H. Spiegel, Bernhard Papenfuß, Jens Dowideit, Caroline Oefele, Volker Gebhardt, Kristina Zappel, Mehmet Gövercin, Thomas König, Claudio Chesi, Anett Reißhauer, Adrian Rosada, Ursula Müller‐Werdan, Anja Heymann, Marion Hanke, Jens Leymann, Thomas Saller, Ann-Cathrin Bischof, Angelika Reisner, Wolf Leopold Albrecht, Julia Wojciechowski, Martina Schuldt, Michael Baum, Dijana Brnabic, Björn von Pickardt, Agnieszka Deutschmann, Carsten C. Scholz, Lars May, Rahel Eckardt‐Felmberg, Isabell Wenghöfer, Manfred Blobner, Sima Sattari, Michael Dummert, Carla Nau, Mareike Otto, Ute Voß-Lümers, D. Lang, Daniel Wiggert
Abstract
BACKGROUND: Frailty is expressed by a reduction in physical capacity, mobility, muscle strength, and endurance. (Pre-)frailty is present in up to 42% of the older surgical population, with an increased risk for peri- and postoperative complications. Consequently, these patients often suffer from a delayed or limited recovery, loss of autonomy and quality of life, and a decrease in functional and cognitive capacities. Since frailty is modifiable, prehabilitation may improve the physiological reserves of patients and reduce the care dependency 12 months after surgery. METHODS: Patients ≥ 70 years old scheduled for elective surgery or intervention will be recruited in this multicenter, randomized controlled study, with a target of 1400 participants with an allocation ratio of 1:1. The intervention consists of (1) a shared decision-making process with the patient, relatives, and an interdisciplinary and interprofessional team and (2) a 3-week multimodal, individualized prehabilitation program including exercise therapy, nutritional intervention, mobility or balance training, and psychosocial interventions and medical assessment. The frequency of the supervised prehabilitation is 5 times/week for 3 weeks. The primary endpoint is defined as the level of care dependency 12 months after surgery or intervention. DISCUSSION: Prehabilitation has been proven to be effective for different populations, including colorectal, transplant, and cardiac surgery patients. In contrast, evidence for prehabilitation in older, frail patients has not been clearly established. To the best of our knowledge, this is currently the largest prehabilitation study on older people with frailty undergoing general elective surgery. TRIAL REGISTRATION: ClinicalTrials.gov NCT04418271 . Registered on 5 June 2020. Universal Trial Number (UTN): U1111-1253-4820.