Karlsson E1, Franzén E1,2,3, Nygren-Bonnier M1,2, Bergenmar M4,5, Rydwik E1,6
1Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden, 2Allied Health Professionals, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden, 3Stockholms Sjukhem R&D Unit, Stockholm, Sweden, 4Karolinska Institutet, Department of Oncology-Pathology, Stockholm, Sweden, 5Department of Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden, 6Stockholm County Council, FOU nu, Research and Development Unit for the Elderly, Järfälla, Sweden
Background: Physical decline appears as a consequence of both cancer and surgical treatment. Extensive deterioration can lead to increased care needs and decreased well-being. Information on short-term physical decline and patient-reported recovery in older people undergoing abdominal cancer surgery is still sparse.
Purpose: We aimed to describe the short-term changes and study the associations between preoperative physical performance and postoperative mobility, as well as patient-reported recovery in this patient group.
Methods: Individuals with data on physical performance and patient-reported recovery on hospital discharge were included in a prospective cohort study. Physical performance tests were conducted prior to surgery and on hospital discharge. Changes from baseline to postoperative values were described, logistic regressions were performed to explore the association between preoperative physical performance and postoperative mobility, and ordinal regression for the association between physical decline and patient-reported recovery.
Results: One-hundred forty individuals (mean age 76.0 ±4.6 years) were included in the analyses. We found the greatest declines in functional leg strength (38%) and walking distance (33%). Twenty participants (15%) were unable to rise from a chair without support on discharge. In the multivariable analyses, better preoperative physical performance was associated with lower odds of limited mobility on discharge. A larger decline in gait speed was associated with greater odds of reporting lower postoperative recovery.
Conclusion(s): This study adds information regarding the magnitude of short-term physical decline and factors associated with postoperative mobility. Declines were most prominent in functional leg strength and walking distance postoperatively, which are important components of mobility and ambulation. Better preoperative physical activity level, walking distance, gait speed, and functional leg strength were associated with lower odds of being unable to rise independently during the postoperative in-hospital period. Hence, functional leg strength and physical capacity may be important modifiable exercise components to include in a preoperative exercise regime for the older surgical population.
Implications: It may be important to improve functional leg strength and physical capacity through exercise prior to abdominal cancer surgery to reduce postoperative physical decline. However, further studies are needed to determine if this might create possibilities for a reduced short-term decline, and a faster recovery of mobility after surgery.
Keywords: physical function, functional decline, geriatric oncology
Funding acknowledgements: The project was funded by FORTE (the Swedish Research Council for Health, Working Life and Welfare).
Purpose: We aimed to describe the short-term changes and study the associations between preoperative physical performance and postoperative mobility, as well as patient-reported recovery in this patient group.
Methods: Individuals with data on physical performance and patient-reported recovery on hospital discharge were included in a prospective cohort study. Physical performance tests were conducted prior to surgery and on hospital discharge. Changes from baseline to postoperative values were described, logistic regressions were performed to explore the association between preoperative physical performance and postoperative mobility, and ordinal regression for the association between physical decline and patient-reported recovery.
Results: One-hundred forty individuals (mean age 76.0 ±4.6 years) were included in the analyses. We found the greatest declines in functional leg strength (38%) and walking distance (33%). Twenty participants (15%) were unable to rise from a chair without support on discharge. In the multivariable analyses, better preoperative physical performance was associated with lower odds of limited mobility on discharge. A larger decline in gait speed was associated with greater odds of reporting lower postoperative recovery.
Conclusion(s): This study adds information regarding the magnitude of short-term physical decline and factors associated with postoperative mobility. Declines were most prominent in functional leg strength and walking distance postoperatively, which are important components of mobility and ambulation. Better preoperative physical activity level, walking distance, gait speed, and functional leg strength were associated with lower odds of being unable to rise independently during the postoperative in-hospital period. Hence, functional leg strength and physical capacity may be important modifiable exercise components to include in a preoperative exercise regime for the older surgical population.
Implications: It may be important to improve functional leg strength and physical capacity through exercise prior to abdominal cancer surgery to reduce postoperative physical decline. However, further studies are needed to determine if this might create possibilities for a reduced short-term decline, and a faster recovery of mobility after surgery.
Keywords: physical function, functional decline, geriatric oncology
Funding acknowledgements: The project was funded by FORTE (the Swedish Research Council for Health, Working Life and Welfare).
Topic: Older people
Ethics approval required: Yes
Institution: The Regional Ethical Board in Stockholm
Ethics committee: The Regional Ethical Board in Stockholm
Ethics number: Dnr: 2015/1179–31
All authors, affiliations and abstracts have been published as submitted.
