A work-in-progress seminar hosted by the Health and Wellbeing Faculty of Social Sciences and Law Research Group

You are invited to a lunchtime (online) Work in Progress meeting to discuss potential collaborations with Maria Pufulete, a senior research fellow in Bristol Medical School. Maria welcomes your feedback and ideas for a research proposal she is developing looking at ‘pre-habilitation’ interventions to improve surgical outcomes in patients undergoing heart surgery.  

Maria is particularly keen to involve colleagues with expertise in:

• Behavioural science, particularly regarding diet/exercise;
• Exercise interventions with clinical populations;
• Development and evaluation of health apps;
• Evaluating the impact of health interventions. 

The Work in Progress session will give those interested in hearing more about Maria’s proposed project, giving feedback from their disciplinary perspective and potentially collaborating with Maria on taking this forwards. 

Maria’s summary of her proposed research 

Prehabilitation (Prehab) is an intervention administered before surgery to optimise patient fitness so that they can withstand surgery better and recover more quickly. Prehab is a multicomponent intervention including exercise (aerobic, resistance and breathing exercises), nutritional and psychological optimisation, and education. Prehab doesn’t have a good evidence base, largely because the interventions tested vary markedly, sometimes including one component and sometimes multiple, so although there are plenty of trials, they are difficult to pool and interpret. Furthermore, prehab interventions have a strong mechanistic basis so prehab has been implemented widely across NHS Trusts/Boards before the evidence base could be built, in the belief that it works. Prehab has been largely offered to cancer and orthopaedi csurgery patients. 

We want to design a prehab intervention for heart surgery patients. Unlike other surgical patients, patients awaiting heart surgery have diseased hearts and their surgery is to fix their heart. As such, there are fears about the safety of undertaking exercise, particularly aerobic exercise, before heart surgery. Consequently, there has been little prehab implemented in heart surgery centres in the UK and many heart surgery patients are told not to exercise until their heart is fixed. Nevertheless, this advice is not based on any hard evidence, and heart surgery has one of the highest complication rates, in particular lung complications, which can be prevented if patients improve their aerobic fitness. Furthermore, about half of all heart surgery patients have urgent surgery – they are in hospital for about 10 days before surgery, precluding a standard prehab programme which is normally about 4 weeks. 

We obtained a NIHR Programme Development Grant (Prehabilitation in cardiac surgery patients) to undertake preparatory work for a Programme Grant which will aim to develop and test a prehab intervention in heart surgery patients. We summarised all the evidence on prehab (Cochrane review and a scoping review), undertook an analysis of routine data to characterise the heart surgery population, and convened two workshops to discuss and produce some guiding principles for a prehab intervention. We are using the person-based approach (Lucy Yardley’s group) to do this. 

We have the following uncertainties:

1. What exercise prescription should be offered to people with severely impaired heart function? How much is safe?
2. What should a nutritional and psychological intervention look like?
3. Where do we deliver the intervention: in hospital or in the community, what features can we add to ensure patient safety (wearables for monitoring)
4. What should the intervention for the urgent pathway look like (in hospital prehab)?
5. How do we improve and monitor adherence?
6. Covid led to “digital prehab”, what is the evidence for effectiveness of digital interventions? 

I am looking for potential collaborations, expertise in the above, different ways of thinking and some discussion to turn the above research into a NIHR Programme Grant (PGfAR). For information, we have a wonderful and engaged PPI group to support this research.

Join via Zoom