Factibilidad y efectos de la prehabilitación en cirugía cardiaca. Estudio preliminar / Feasibility and effects of prehabilitation in cardiac surgery. Preliminary study

Objetivo: Evaluación de la factibilidad de un programa de prehabilitación multimodal y su efecto sobre la capacidad funcional en pacientes candidatos a cirugía cardiaca electiva. Métodos: Estudio piloto realizado desde julio de 2017 hasta junio de 2018 en pacientes candidatos a revascularización miocárdica y/o recambio valvular. El programa consistió en: 1) programa de entrenamiento físico supervisado, 2) incentivación respiratoria, 3) soporte nutricional y 4) entrenamiento en mindfulness. Se realizó una evaluación previa al inicio del programa y al finalizar el mismo (preoperatoriamente). Resultados: Todos los pacientes, excepto uno que rechazó la cirugía, completaron el programa, que tuvo una duración media de 45 días. Ningún paciente presentó complicaciones relacionadas con el programa. El programa indujo un aumento significativo de la capacidad funcional medido por el test de la marcha de seis minutos (510,7+62m vs. 534,3+71m; p=0,007) y el test de la silla (13,2+4,7 vs. 16,4+7 repeticiones; p=0,02), así como un aumento del nivel de actividad física medido mediante el cuestionario de actividad física de Yale (37,6+20 vs. 54,2+27; p=00029). Conclusiones: La prehabilitación multimodal en pacientes candidatos a cirugía cardiaca electiva es factible y aumenta la capacidad funcional preoperatoriamente sin asociarse a complicaciones. El presumible impacto beneficioso de esta mejora sobre la incidencia de complicaciones postoperatorias y estancia hospitalaria requiere ser investigado.(AU)

Objective: Evaluation of the feasibility of a multimodal prehabilitation program and its effect on functional capacity in patients candidates for elective cardiac surgery. Methods: Pilot study conducted from July 2017 to June 2018 in patients candidates to myocardial revascularization and/or valve replacement. The program consisted of: 1) supervised exercise training program, 2) breathing incentive exercises, 3) nutritional support, and 4) mindfulness training. An evaluation was carried out prior to the start of the program and at the end of it (preoperatively). Results: All patients except one who refused surgery, completed the program, which lasted an average of 45 days. No patients presented complications related to the program. The program induced a significantly increase in functional capacity measured by the six-minute walking test (510.7+62m vs 534.3+71m, P=.007) and the chair test (13.2+4, 7 vs 16.4+7 repetitions, P=.02), as well as an increase in the level of physical activity measured by the Yale physical activity questionnaire (37.6+20 vs 54.2+27; P=00029). Conclusions: Multimodal prehabilitation in patients candidates for elective cardiac surgery is feasible and it increases functional capacity preoperatively without being associated with complications. The presumed beneficial impact of this improvement on the incidence of postoperative complications and hospital stay, requires further investigation.(AU)

Feasibility and effects of prehabilitation in cardiac surgery. Preliminary study.

Prehabilitation programs that combine exercise training, nutritional support, and emotional reinforcement have demonstrated efficacy as a strategy for preoperative optimization in abdominal surgery. The experience in cardiac surgery, one of those associated with greater morbidity and mortality, is anecdotal. OBJECTIVE: evaluation of the feasibility of a multimodal prehabilitation program and its effect on functional capacity in patients candidates for elective cardiac surgery. METHODS: Pilot study conducted from July 2017 to June 2018 in patients candidates to myocardial revascularization and/or valve replacement. The program consisted of: 1) supervised exercise training program, 2) breathing incentive exercises, 3) nutritional support, and 4) mindfulness training. An evaluation was carried out prior to the start of the program and at the end of it (preoperatively). RESULTS: All patients except one who refused surgery, completed the program, which lasted an average of 45 days. No patients presented complications related to the program. The program induced a significantly increase in functional capacity measured by the six-minute walking test (510.7 + 62 m vs 534.3 + 71 m, p = 0.007) and the chair test (13.2 + 4, 7 vs 16.4 + 7 repetitions, p = 0.02), as well as an increase in the level of physical activity measured by the Yale physical activity questionnaire (37.6 + 20 vs 54.2 + 27; p = 00029). CONCLUSIONS: Multimodal prehabilitation in patients candidates for elective cardiac surgery is feasible and it increases functional capacity preoperatively without being associated with complications. The presumed beneficial impact of this improvement on the incidence of postoperative complications and hospital stay, requires further investigation.

Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial.

RATIONALE: Reduced physical activity (PA) in patients with COPD is associated with a poor prognosis. Increasing PA is a key therapeutic target, but thus far few strategies have been found effective in this patient group. OBJECTIVES: To investigate the effectiveness of a 12-week semiautomated telecoaching intervention on PA in patients with COPD in a multicentre European randomised controlled trial. METHODS: 343 patients from six centres, encompassing a wide spectrum of disease severity, were randomly allocated to either a usual care group (UCG) or a telecoaching intervention group (IG) between June and December 2014. This 12-week intervention included an exercise booklet and a step counter providing feedback both directly and via a dedicated smartphone application. The latter provided an individualised daily activity goal (steps) revised weekly and text messages as well as allowing occasional telephone contacts with investigators. PA was measured using accelerometry during 1 week preceding randomisation and during week 12. Secondary outcomes included exercise capacity and health status. Analyses were based on modified intention to treat. MAIN RESULTS: Both groups were comparable at baseline in terms of factors influencing PA. At 12 weeks, the intervention yielded a between-group difference of mean, 95% CI (lower limit - upper limit; ll-ul) +1469, 95% CI (971 to 1965) steps/day and +10.4, 95% CI (6.1 to 14.7) min/day moderate PA; favouring the IG (all p≤0.001). The change in 6-min walk distance was significantly different (13.4, 95% CI (3.40 to 23.5) m, p<0.01), favouring the IG. In IG patients, an improvement could be observed in the functional state domain of the clinical COPD questionnaire (p=0.03) compared with UCG. Other health status outcomes did not differ. CONCLUSIONS: The amount and intensity of PA can be significantly increased in patients with COPD using a 12-week semiautomated telecoaching intervention including a step counter and an application installed on a smartphone. TRIAL REGISTRATION NUMBER: NCT02158065.

Análisis descriptivo de la fisioterapia respiratoria en España / Descriptive analysis of respiratory physiotherapy in Spain

Introducción. La fisioterapia respiratoria (FR) consiste en un conjunto de estrategias destinadas a la prevención, el tratamiento y la estabilización de las alteraciones cardiorrespiratorias en pacientes adultos y pediátricos. El objetivo del presente estudio fue describir la situación de la FR en España en el ámbito asistencial, docente, y de investigación. Métodos. Se diseñó un cuestionario on-line para obtener información sobre la implementación de la FR en España en los ámbitos asistencial, docente, y de investigación. El cuestionario quedó disponible on-line entre octubre de 2010 y enero de 2011 para todos aquellos profesionales interesados en contestarlo. Solo se aceptaron respuestas de fisioterapeutas titulados que vivían y trabajaban en España, a razón de una respuesta por persona. Resultados. Se obtuvieron 793 respuestas válidas a partir de las cuales se determinó que un 67,8% del total de participantes estaban vinculados asistencialmente a la FR. De estos, un 79,3% lo hacían de manera esporádica y solo un 50,4% tenían formación específica. Los tratamientos de FR se realizaban básicamente en hospitales (35,5%), centros privados (31%) o en el domicilio del paciente (16,9%). Un 16,4% de los participantes estaban vinculados a docencia en FR y tenían amplia formación específica. Solo un 11,7% de los encuestados estaban involucrados en proyectos de investigación relacionados con FR, pero generalmente lo hacían de manera esporádica y en combinación con tareas asistenciales o docentes. Conclusiones. La FR en España tiene una baja implementación y dedicación laboral. El nivel de formación específica de los fisioterapeutas que realizan intervenciones de FR es aceptable aunque limitado (AU)

Introduction. Respiratory physiotherapy (RP) consists of a combination of strategies aiming to prevent, treat and stabilize cardiorespiratory disorders in adult and pediatric patients. The aim of this study was to describe RP in Spain in the settings of clinical practice, teaching and research. Methods. An on-line questionnaire was designed to obtain information about the implementation of RP in Spain in settings such clinical practice, teaching and research. The questionnaire was available on-line between October 2010-January 2011 to all professionals interested in completing it. Only responses from graduate physiotherapists living and working in Spain were accepted, at a rate of one answer per person. Results. A total of 793 valid answers were obtained, revealing that 67.8% of the respondents were involved in RP in clinical practice, but that 79.3% of respondents practicing RP did so occasionally and only 50.4% had specific RP training. RP treatments were mostly implemented in hospitals (35.5%), private centers (31%) or at patients’ homes (16.9%). Overall, 16.4% of the participants were involved in RP teaching, and most of them had specific training in RP. Only 11.7% of the respondents were involved in research projects related to RP, and most of this participation was sporadic or combined with clinical or teaching tasks. Conclusions. Respiratory physiotherapy is not widely implemented or practiced in Spain. Professionals providing RP interventions have an acceptable level of training but training is scarce (AU)