Background: Evidence suggests that elective cardiac patients are at risk of functional and psychological deterioration\nin the time preceding surgery. This poses a risk to successful post-operative rehabilitation. This prospective one-group\npre-test, post-test evaluation was designed to assess a clinical Pre-operative Rehabilitation (PREHAB) home-based\nexercise programme, to optimise pre-operative physical function and frailty in patients awaiting elective Coronary\nArtery By-Pass Graft (CABG) or Valve Surgery.\nMethod: Consenting patients awaiting cardiac surgery, with wait time ââ?°Â¥ 6 weeks were referred to a Senior Physiotherapist\nfor baseline assessment. Patients were offered PREHAB in the form of functional home-based exercise that was prescribed\nfrom baseline physical outcomes. All patients were followed up via telephone to ensure progression of exercise and any\nproblems associated with it. This continued weekly until the patient attended Surgical Pre-assessment clinic, where all\noutcome measures were re-assessed.\nResults: Twenty two patients, out of a total number of 36 patients seen in the surgical clinic between March 2016 and\nAugust 2016, participated in the prehab clinical evaluation. Twenty patients completed their prescribed exercises on a\nweekly basis prior to surgery. No adverse events or cardiac symptoms were reported as a result of the home exercise\nintervention. Paired t-Test analyses revealed a significant mean difference in clinical frailty score (CFS) of âË?â??0.53 Ã?± 0.51\n(95% CI [âË?â??0.774, âË?â??0.279], P = 0.0003). Significant mean difference in six-minute walk test (6MWT) distance of 42.5 Ã?± 27.\n8 m (95% CI [23.840, 61.251], P = 0.0005), 6MWT walking speed of 0.5 Ã?± 0.4kmh (95% CI, [0.2433, 0.7567],\nP = 0.001), and short physical performance battery (SPPB) total score of 2.2 Ã?± 1.7, (95% CI [3.066, 1.200],\nP = 0.0002) were also observed. The change in 6MWT distance was shown to be significantly associated\nwith hospital length of stay (LOS) (r = 0.7; P = 0.03).\nConclusion: This small exploratory evaluation suggests that providing a home-based PREHAB programme for frail\npatients undergoing CABG or Valve surgery may be able to improve functional ability and reduce hospital length of stay\nfor those patients undergoing cardiac surgery. A frailty score with greater sensitivity may be required to elucidate the\ninfluence frailty could have in reducing length of stay. A large randomised controlled study is required to reveal the\npotential beneficial effects of PREHAB in this patient population.
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