Colorectal Surgery Clinical Trial
Official title:
Very Early Mobilization of Colorectal Surgery Patients - A Randomized Controlled Trial
Early mobilization is an important part of Enhanced Recovery Programs (ERP)in colorectal surgery. The aim of this randomized controlled trial is to investigate the impact of very early mobilization, starting within 1 hour after surgery, on further mobilization within an existing Enhanced Recovery Program.
Post-operative bed rest and immobility has a negative effect on morbidity and mortality after
colorectal surgery.To prevent immobilization early mobilization is a well established part of
Enhanced Recovery Programs. This facility uses protocols developed by the ERAS (Enhanced
Recovery After Surgery)-society. However not all patients can reach the level physical
activity needed to be in compliance with the ERP. This being more frequent in the elderly
frail patient. This may contribute to longer hospital stay and increase the risk of
complications. The aim of this trial is to investigate if a very early mobilization
intervention will lead to a higher lever of physical activity after surgery compared with
standard-care.
The aim is to include 150 patients scheduled to undergo colorectal surgery. Patients will
receive written and verbal information about the trial before written consent is obtained.
The patients will undergo an extended pre-operative assessment during which a baseline for
patients physical activity level will be established before surgery. For this purpose the
patients will be evaluated by a physiotherapist with the following tools; 6-minutes walk
test, Timed up and go-test (TUG), mini modified Functional Independence Measure (mFIM), WHO
disability assessment score (WHODAS) and activity measurement with accelerometry for up to 7
days. (Actigraph GT3X device)
The randomization will take place on the day of the surgery and the patients will be assigned
to either intervention (very early mobilization) or control group (standard post-operative
care). A stratified randomization will be performed to ensure an even spread within three
patient categories: Laparoscopic surgery, Open surgery and Rectum amputation. The
randomization is performed using concealed allocation where envelopes are prepared externally
using a randomization list prepared by a statistician.
After surgery the patients will be transferred to the post-operative care unit where the
patients included in the intervention group will be mobilized with the help of a
physiotherapist and post-operative unit staff. The intervention will begin as early as 30
minutes after arrival in the post-operative unit. The intervention will follow the Surgical
ICU Optimal Mobilization Score (SOMS) which includes four steps of mobilization from movement
in bed up to walking. Progress from each step to the next will be conditioned with patient
fulfilling criteria for a safe mobilization including stable physiological parameters and
adequate pain situation. The patients in the standard care group will not receive the
intervention.
All patients will receive information about early mobilization. The patients will not receive
information on the timing of the mobilization intervention in an effort to remain blinded to
the intervention. The patient in the standard care group will be mobilized accordingly to the
ERP protocol, which also includes early mobilization in the surgical ward. Upon transfer from
the post-operative unit to the surgical ward all study patients will be again fitted with the
activity monitor to measure their physical activity during the post-operative phase.
During hospital stay all study patients will be subject to routine mobilization within the
existing ERP protocol. To determine the physical activity level the patient will be wearing
the activity monitoring device until discharge from the surgical ward. The study patients
will also be evaluated by blinded physiotherapists with mFIM and 6 minutes walk-test. In
addition information will be gathered regarding routine documentation on patient mobilization
progress to measure adherence to ERP goals.
After four to six weeks the patients are scheduled for a standard post-operative follow-up
visit. The study patients will then also meet a blinded physiotherapist that previously was
not participating in the intervention who will repeat the following tests: 6 minutes
walk-test, WHODAS, TUG. All study patients will also be instructed to wear the activity
monitor for additional seven days to again measure their physical activity level. All
patients who have undergone the intervention will be scheduled for a semi-structured
telephone interview about their perception of the SOMS intervention.
Follow-up questionnaire with WHODAS self-reported questions will be gathered through a
telephone interview with the patients three, six and twelve months after surgery.
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