CRIB (Cancer Rehabilitation In Bowel cancer): the use of cardiac rehabilitation services to aid the recovery of colorectal cancer patients: a pilot randomised controlled trial (RCT) with embedded feasibility study
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ABSTRACT:
DISEASE(S): Colorectal Cancer
PROVIDER: 2421110 | ecrin-mdr-crc |
REPOSITORIES: ECRIN MDR
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Project description:IntroductionPatients with colorectal cancer report ongoing physical and psychological impairments and a high proportion of these patients are overweight, insufficiently active and high-risk drinkers, putting them at risk of poor recovery and risk of recurrence and comorbidities. A challenge is implementing sustainable and effective rehabilitation as part of routine care for this group.Methods and analysisA two-arm pilot randomised controlled trial (RCT) with embedded feasibility study undertaken as a phased programme of work. The intervention involves an existing cardiac rehabilitation programme for cardiac patients accepting colorectal cancer patient referrals. The intervention consists of supervised exercise sessions run by a cardiac physiotherapist and information sessions. Phase 1 will involve one research site enrolling 12 patients to assess intervention and study design processes. Semistructured interviews with patients with colorectal cancer and cardiac patients and clinicians will be used to gather data on acceptability of the intervention and study procedures. Phase 2 will involve three sites enrolling 66 patients with colorectal cancer randomised to control or intervention groups. Outcome measures will be taken preintervention and postintervention, for phases 1 and 2. The primary outcome is accelerometer measured physical activity; secondary outcomes are self-report physical activity, quality of life, anxiety, depression, symptoms including fatigue. The following variables will also be examined to determine if these factors influence adherence and outcomes: self-efficacy, risk perception and treatments.Ethics and disseminationFull ethical approval was granted by NRES Committees-North of Scotland (13/NS/0004; IRAS project ID: 121757) on 22 February 2013. The proposed work is novel in that it aims to test the feasibility and acceptability of using an evidence-based and theory driven existing cardiac rehabilitation service with patients with colorectal cancer. Should this model of rehabilitation prove to be clinically and cost effective we aim to conduct a randomised controlled trial of this intervention to measure effectiveness.Trial registration referenceISRCTN63510637; UKCRN id 14092.
| S-EPMC3931997 | biostudies-literature
Project description:See http://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-trial-looking-at-exercise-to-help-recovery-after-bowel-cancer-surgery-prepare-abc
| 2424367 | ecrin-mdr-crc
Project description:OBJECTIVE:To examine the long-term effect of a socially differentiated cardiac rehabilitation (CR) intervention tailored to reduce social inequalities in health regarding use of healthcare services in general practice and hospital among socially vulnerable patients admitted with first-episode myocardial infarction (MI). DESIGN:A prospective cohort study with 10 years' follow-up. SETTING:Department of cardiology at a university hospital in Denmark between 2000 and 2004. PARTICIPANTS:Patients <70 years admitted with first-episode MI categorised as socially vulnerable (n=208) or non-socially vulnerable (n=171) based on educational level and social network. INTERVENTION:A socially differentiated CR intervention. The intervention consisted of standard CR and expanded CR with focus on cross-sectional collaboration. MAIN OUTCOME MEASURES:Participation in annual chronic care consultations in general practice, contacts to general practice, all-cause hospitalisations and cardiovascular readmissions. RESULTS:At 2-year and 5-year follow-up, socially vulnerable patients receiving expanded CR participated significantly more in annual chronic care consultations (p=0.02?and p<0.01) but at 10-year follow-up, there were no significant differences in annual chronic care consultations (p=0.13). At 10-year follow-up, socially vulnerable patients receiving standard CR had significantly more contacts to general practice (p=0.03). At 10-year follow-up, there were no significant differences in the proportion of socially vulnerable patients receiving expanded CR in the mean number of all-cause hospitalisations and cardiovascular readmissions (p>0.05). CONCLUSIONS:The present study found no persistent association between the socially differentiated CR intervention and use of healthcare services in general practice and hospital in patients admitted with first-episode MI during a 10-year follow-up.
| S-EPMC6830639 | biostudies-literature
Project description:To determine the preferred means by which participants in a study of cardiac rehabilitation wish to be informed of the study's results.Postal questionnaire survey of participants in a randomized controlled trial.Cornwall, southwest England.Patients recruited to the Cornwall Heart Attack Rehabilitation Management Study (CHARMS).Participants recruited to CHARMS who were alive 3 years and 9 months after the trial was completed were contacted by letter and invited to return a reply slip with four short questions indicating how they would prefer to be informed about the published results of the study.In March 2008, 191/230 participants originally recruited to CHARMS were still alive. General practitioners deemed 166/191 (88%) survivors medically appropriate to be contacted through a postal survey, and 154/166 (93%) participants responded to the invitation to participate in the follow-up survey. 86% (143/166) of participants indicated that they wished to be informed about the results: 115 (80%) of these elected to receive information by letter and 25 (18%) of these preferred to attend a meeting. Men older than 65 years predominated in this latter group. Women respondents preferred to receive the study results by letter; none preferred communication by email or the web.Survivors of acute myocardial infarction who participated in a RCT of cardiac rehabilitation wanted to receive a summary of the aggregate study results. Participants had preferences regarding how they would wish to be informed about the results of the study. Most participants preferred to be informed by letter or email, but some preferred the interaction of a group or a meeting.
| S-EPMC5060540 | biostudies-literature
Project description:OBJECTIVES:To characterize rehabilitation services use of older adults according to fall-risk classification based on screening guidelines. DESIGN:Cross-sectional analysis of 2015 National Health and Aging Trends Study. SETTING:Study participants' homes. PARTICIPANTS:National sample of 7,440 community-dwelling Medicare beneficiaries. MEASUREMENTS:In-person interviews and functional assessments. Based on Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths and Injuries criteria, participants were classified as low, moderate, or high fall risk. RESULTS:Twenty-three percent of older adults classified as moderate fall-risk (n = 2602) and 40.6% of those at high fall-risk (n = 940) reported rehabilitation services use in the past year. Among older adults who reported rehabilitation services in the past year (n = 1,505), treatment to address falls was reported by 2.8%, 12.6%, and 34.7% of those classified with low, moderate, and high fall-risk, respectively (p < 0.001). Older adults with high fall-risk who did not receive rehabilitation services had significantly better self-reported physical capacity (p = 0.02) but comparable physical performance (all p's > 0.05) relative to those who received rehabilitation. CONCLUSION:Older adults at high risk for falls were significantly more likely to report rehabilitation services use compared to those with low and moderate risk of falling. The findings also indicate that there is low adherence to national clinical recommendations for rehabilitation services use in older adults vulnerable to falls-related injury. Among the high fall-risk group, those who did not receive rehabilitation services had similarly low physical function as compared with those who received rehabilitation, indicating potential unmet need to address physical impairments related to fall-risk. J Am Geriatr Soc 67:100-107, 2019.
| S-EPMC6322948 | biostudies-literature
Project description:Cell genesis and synaptic plasticity in the adult brain and spinal cord can be influenced by stress, and enriched environment and physical exercise, which promotes the re-expression in adults of a series of intrinsic and extrinsic factors that may be important to stimulte a cell to re-enter growth mode and thus promote regeneration of the damaged system. We used microarray to identify genes that could explain some possible mechanisms involved in motor function recovery and detail the global programme of gene expression undelying plasticity and regeneration process after a spinal cord injury and identified distict classes of up-regulated and down-regulated genes during this process
2024-01-26 | GSE223820 | GEO
Project description:Research has shown that physical activity is essential in the prevention and treatment of chronic diseases like cardiovascular disease (CVD). Smart wearables (e.g., smartwatches) are increasingly used to foster and monitor human behaviour, including physical activity. However, despite this increased usage, little evidence is available on the effects of smart wearables in behaviour change. The little research which is available typically focuses on the behaviour of healthy individuals rather than patients. In this study, we investigate the effects of using smart wearables by patients undergoing cardiac rehabilitation. A field experiment involving 29 patients was designed and participants were either assigned to the study group (N = 13 patients who finished the study and used a self-tracking device) or the control group (N = 16 patients who finished the study and did not use a device). For both groups data about physiological performance during cardiac stress test was collected at the beginning (baseline), in the middle (in week 6, at the end of the rehabilitation in the organized rehabilitation setting), and at the end of the study (after 12 weeks, at the end of the rehabilitation, including the organized rehabilitation plus another 6 weeks of self-organized rehabilitation). Comparing the physiological performance of both groups, the data showed significant differences. The participants in the study group not only maintained the same performance level as during the midterm examination in week 6, they improved performance even further during the six weeks that followed. The results presented in this paper provide evidence for positive effects of digital self-tracking by patients undergoing cardiac rehabilitation on performance of the cardiovascular system. In this way, our study provides novel insight about the effects of the use of smart wearables by CVD patients. Our findings have implications for the design of self-management approaches in a patient rehabilitation setting. In essence, the use of smart wearables can prolong the success of the rehabilitation outside of the organized rehabilitation setting.
| S-EPMC5636132 | biostudies-literature
Project description:To examine racial differences in the use of rehabilitation services and functional improvement during receipt of services.Secondary analysis of the 2016 National Health and Aging Trends Study (NHATS).Standardized in-person home interviews.Community-dwelling Medicare enrollees (N = 6,309), 1,276 of whom reported receiving rehabilitation services in the previous 12 months.Self-reported use of rehabilitation services, setting (inpatient, outpatient, home based), reason for use, and perceptions of change in functioning after receiving services.Controlling for sex, dual eligibility for Medicaid, age, number of chronic conditions, functional mobility at the prior round, income, and geographic region, the odds of receiving rehabilitation services in any setting was 1.38 times as great in whites as in blacks (95% confidence interval = 1.09-1.75). Of those receiving therapy, whites were more likely to receive home-based and inpatient rehabilitation services, but there were no racial differences in improvement in function.Strategies are needed to identify possible barriers to use of rehabilitation services for vulnerable groups of aging individuals who need rehabilitation services, particularly older blacks.
| S-EPMC5729093 | biostudies-other
Project description:ObjectiveTo comprehensively update and survey the current provision of recovery, rehabilitation and follow-up services for adult critical care patients across the UK.DesignCross-sectional, self-administered, predominantly closed-question, electronic, online survey.SettingInstitutions providing adult critical care services identified from national databases.ParticipantsMultiprofessional critical care clinicians delivering services at each site.ResultsResponses from 176 UK hospital sites were included (176/242, 72.7%). Inpatient recovery and follow-up services were present at 127/176 (72.2%) sites, adopting multiple formats of delivery and primarily delivered by nurses (n=115/127, 90.6%). Outpatient services ran at 130 sites (73.9%), predominantly as outpatient clinics. Most services (n=108/130, 83.1%) were co-delivered by two or more healthcare professionals, typically nurse/intensive care unit (ICU) physician (n=29/130, 22.3%) or nurse/ICU physician/physiotherapist (n=19/130, 14.6%) teams. Clinical psychology was most frequently lacking from inpatient or outpatient services. Lack of funding was consistently the primary barrier to service provision, with other barriers including logistical and service prioritisation factors indicating that infrastructure and profile for services remain inadequate. Posthospital discharge physical rehabilitation programmes were relatively few (n=31/176, 17.6%), but peer support services were available in nearly half of responding institutions (n=85/176, 48.3%). The effects of the COVID-19 pandemic resulted in either increasing, decreasing or reformatting service provision. Future plans for long-term service transformation focus on expansion of current, and establishment of new, outpatient services.ConclusionOverall, these data demonstrate a proliferation of recovery, follow-up and rehabilitation services for critically ill adults in the past decade across the UK, although service gaps remain suggesting further work is required for guideline implementation. Findings can be used to enhance survivorship for critically ill adults, inform policymakers and commissioners, and provide comparative data and experiential insights for clinicians designing models of care in international healthcare jurisdictions.
| S-EPMC8491421 | biostudies-literature
Project description:OBJECTIVE:To examine the association between hospital-based rehabilitation service use and all-cause 30-day hospital readmission among patients with ischemic stroke. DESIGN:Secondary analysis of inpatient Medicare claims data using Standard Analytical Files. SETTING:Acute hospitals across the United States. PARTICIPANTS:From nationwide data, Medicare fee-for-service beneficiaries (N=88,826) aged 66 years or older hospitalized for ischemic stroke between January to November 2010. INTERVENTIONS:Hospital-based rehabilitation services were quantified using Medicare inpatient claims revenue center codes for evaluation (occupational therapy [OT] and physical therapy [PT]), as well as the number of therapy units delivered. Therapy minutes for both OT and PT services were categorized into none, low, medium, and high. MAIN OUTCOME MEASURES:All-cause 30-day hospital readmission. A generalized linear mixed model was used to examine the effect of hospital-based rehabilitation services on 30-day hospital readmission, after adjusting for patient and hospital characteristics. RESULTS:In fully adjusted models, compared to patients who received no PT, we observed a monotonic inverse relationship between the amount of PT and hospital readmission. For low PT (30 minutes), the odds ratio (OR) was 0.90 (95% confidence interval [CI], 0.83-0.96). For medium PT (>30 to ≤75 minutes), the OR was 0.89 (95% CI, 0.82-0.95). For high PT (>75 minutes), the OR was 0.86 (95% CI, 0.80-0.93). CONCLUSION:Hospital-based PT services were associated with lower risk of 30-day hospital readmission in patients with ischemic stroke.
| S-EPMC6599551 | biostudies-literature