This is a post-hoc analysis of the PREhabilitation for improving QUality of recovery after ELective cardiac surgery (PREQUEL) trial (ChiCTR1800016098). The objective of this study was to compare the effects of early postoperative recovery on participants’ self-rated health status at 90 days after elective cardiac surgery between prehabilitation groups.
The study involved 164 participants (115 males, 49 females), who were randomised to either hospital-based exercise prehabilitation (treatment group) or usual care (control group) between July 2018 and October 2023. Seventy-one (86.6%) in the prehabilitation group and 69 (84.1%) in the control group were considered vulnerable by the Clinical Frailty Scale (CFS of 4). 138 patients received open heart surgery (coronary artery bypass grafting ± valve or isolated valve surgery). The 15-item Quality of Recovery (QoR-15) questionnaire, which measures pain, physical comfort, physical independence, psychological support and emotional state post-surgery, was given to participants on the third day after cardiac surgery (POD3). The QoR-15 score ranges from 0 (no recovery) to 150 (excellent recovery). At 90 days after surgery (POD90), participants rated their health state from 0 (worst imaginable) to 100 (best imaginable) using the EuroQoL 5-dimension 5-level questionnaire (EQ5D) visual analogue scale (VAS). A quadratic model containing treatment group, treatment group*QoR-15 score interaction, type of surgery and without a constant was used to illustrate the curvilinear relationships of EQ5D VAS on QoR-15 by treatment group.
In the intention-to-treat analysis, there were 69 participants in both prehabilitation and usual care groups. The mean ± SD QoR-15 scores in the prehabilitation (n=67) and control (n=65) groups were 106.0 ± 20.2 and 105.3 ± 18.5, respectively. The mean ± SD EQ5D VAS in the prehabilitation (n=68) and control (n=60) groups were 75.4 ± 14.2 and 75.0 ± 16.2, respectively. The prehabilitation group’s upward curvature differed from the control group’s downward curvature (F=4.46, P=0.037). Even when the early postoperative recovery was poor (QoR-15 score of 50), the participants in the prehabilitation group reported higher self-rated health status (78.8 ± 6.9) compared to those in the control group (37.0 ± 11.1) (P0.010). However, the group differences in self-rated health status were no longer observed when QoR-15 score exceeded 80.
In a predominately vulnerable cardiac surgical population, participants who received physical prehabilitation had a greater functional reserve, leading to a higher perception of good health status at POD90, particularly if they had a poor early recovery, compared to the control participants.
The findings suggest that the trajectory back to preoperative health status is quicker in participants who received prehabilitation compared to those who did not. Physiotherapists have a unique role in helping patients enhance their preoperative well-being, and ultimately regaining their quality of life after surgery.
Physical prehabilitation
Patient-centred outcomes
