P54. Preoperative community based functional exercise training with high-risk patients opting for lumbar spinal fusion: A pilot study

Abstract

<h3>BACKGROUND CONTEXT</h3> Undergoing major surgery is associated with a substantial risk of decreased functioning, morbidity and mortality. Preoperative exercise training with high-risk patients before major surgery decreases their risk of adverse postoperative outcomes. This may also apply to high-risk patients opting for lumbar spinal fusion (LSF). However, research on prehabilitation programs for patients undergoing LSF focus on relatively fit "low-risk" patients and achieve no or very limited benefits. Therefore, a focus on "high-risk" patients is warranted, as these patients will probably benefit most from prehabilitation. <h3>PURPOSE</h3> To determine the feasibility and preliminary effectiveness of community-based high-intensity functional interval training (HIFIT) program with high-risk patients opting for LSF. <h3>STUDY DESIGN/SETTING</h3> In this pilot case control study trained high-risk cases were matched 1:1 with untrained high-risk controls from a retrospective cohort. From November 2018 onwards, the preoperative community-based HIFIT program was implemented into standard care. From that moment onwards, all high-risk patients (n=23) were offered the HIFIT program within their own living context. <h3>PATIENT SAMPLE</h3> High-risk patients were identified during a preoperative risk screening, measuring a patient's fitness level using the Steep Ramp Test (SRT). All adult high-risk patients opting for elective 1-3 level LSF diagnosed with degenerative disorders of the lumbar spine were eligible for inclusion. <h3>OUTCOME MEASURES</h3> The primary outcome measure was time to functional recovery, in other words: the number of days until the patient was able to ambulate independently in the hospital. Secondary outcome measures were: length of hospital stay (LoS), participation rate, related adverse events, percentage of sessions at which high training intensity was reached (measured with BORG rating of perceived exertion and heart rate (HR)) and progression in physical fitness level from baseline till the day of surgery (measured with the SRT). <h3>METHODS</h3> Preliminary effectiveness was measured, using 1) a Mann-Whitney U test and 2) an interrupted time series analysis (ITSA). <h3>RESULTS</h3> Trained high-risk patients obtained faster time to functional recovery (mean difference (MD)= -3.82, p=0.014), but equal LoS (MD= -0.920, p=0.691) compared to their matched controls. The ITSA showed a positive effect of implementation of the HIFIT program on time to functional recovery (relative risk (RR)= 0.540 (95% Confidence Interval (CI)=0.32-0.92), p=0.023), but no effect on LoS (RR= 0.650 (CI=0.41-1.03), p=0.066). Participation rate in this pilot study was moderate; 47.8% (n=11) of all eligible high-risk patients were trained. The program was safe and feasible for high-risk patients that chose to participate in the HIFIT program, as no adverse events occurred and only one out of 74 sessions was missed. Patients reached adequate training intensity in 71% or 0% of the training sessions, based on the BORG and HR respectively. Trained patients increased their preoperative physical fitness by 17.6% on average in 5 training weeks. <h3>CONCLUSIONS</h3> The program shortened time to functional recovery, but not LoS. The community-based HIFIT program is feasible and safe for high-risk patients undergoing LSF. Methods for improvement of participation rates and achieving adequate training intensity should be studied. This pilot study helps guide future research on prehabilitation for patients opting for LSF and aids in the implementation of a preoperative exercise program for high-risk patients undergoing LSF. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.