A Home-based Pre-Surgical Exergaming Intervention for Individuals With Advanced HF and Multiple Chronic Conditions Prior to Left Ventricular Assist Device Implantation or Heart Transplant
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 2
- 试验地点
- 2
- 主要终点
- Change in Functional Capacity from Baseline
研究概览
简要总结
The purpose of this study is to test a home-based exergaming intervention designed to decrease frailty and fatigue and improve affective well-being, functional capacity, and immune function in individuals with advanced heart failure (HF) and multiple chronic conditions (MCC) prior to receiving either a left ventricular assist device (LVAD) or orthotopic heart transplantation (OHT). Prior to surgery, individuals with advanced HF/MCC experience a high symptom burden that often precludes them from participating in meaningful physical activity. Pre-surgical fitness programs have been used in other critically ill populations to improve function prior to surgery. Interactive gaming systems have been successfully used to engage other seriously ill adults in low-intensity physical activity. However, exergaming interventions have not yet been applied in individuals with advanced HF/MCC as prehabilitation prior to LVAD implantation or OHT. The investigators propose that a prehabilitation exergaming intervention will not only enhance pre-surgical outcomes but will also augment postoperative outcomes. This study is designed in two-phases. Phase 1 examines intervention feasibility and phase 2 is a pilot study with a two-group design. In phase 2, participants will be randomized to a usual care group or the exergaming intervention group. The exergaming group will participate in a low-intensity exergaming intervention and additional investigator-developed educational modules that will be delivered via the Nintendo Wii U exergaming system. The investigators will evaluate pre- and post-surgical frailty, fatigue, affective well-being, and immune function as primary outcomes. The investigators expect that participation in low intensity exergaming will improve these primary outcomes pre- and post-surgically, and decrease post-surgical complications and health care utilization. Investigator-developed modules will promote self-efficacy, self-regulation, and activation. This is the first study to apply low-intensity exergaming to a pre-operative advanced HF/MCC population. The successful application of this intervention has significant implications to the pre-operative conditioning of individuals with advanced HF/MCC prior to LVAD implantation or OHT.
详细描述
Specific Aims. The objectives of this study are two-fold: (1) To test the feasibility of a low intensity, home-based exergaming intervention in individuals with advanced HF/MCC prior to left ventricular assist device (LVAD) implantation or orthotopic heart transplantation (OHT), and (2) To examine the effectiveness of delivering a low intensity, home-based exergaming intervention to decrease frailty and fatigue and improve affective well-being, functional capacity, and immune function in individuals with advanced HF/MCC prior to receiving an LVAD or OHT.
Other surgical populations who were deconditioned, fatigued, and frail before surgery have benefited from the use of pre-surgical fitness interventions (prehabilitation).3-5 Innovative interventions strategies, like the Nintendo Wii Fit exergaming system, have been successful at engaging seriously ill adults in low-intensity physical activity6,7. However, exergaming interventions have not yet been applied in individuals with advanced HF as prehabilitation prior to LVAD implantation or OHT. The investigators propose that a home-based, prehabilitation exergaming intervention will not only enhance pre-surgical outcomes but will also augment postoperative outcomes.
The investigators will conduct this study in two phases. Phase 1 is designed as a feasibility study in a smaller sample (5 participants and 5 informal caregivers) to allow initial evaluation of the intervention including troubleshooting the technological components and evaluating study recruitment, retention, and intervention safety prior to initiating the larger, two-group randomized study. Phase 2 will enroll a convenience sample of 40 participants with advanced HF/MCC who are being evaluated for LVAD implantation or OHT at Nebraska Medicine and their 40 informal caregivers for a total sample of 80 enrollees (n=40 exergaming, n=40 usual care).
In both phases, the exergaming group will participate in a low-intensity exergaming intervention and additional investigator-developed educational modules (e.g. symptoms while exercising, exercising with heart failure) that will be delivered via the Nintendo Wii U exergaming system. Investigator-developed modules are designed to promote self-efficacy, self-regulation, and activation. Individuals with advanced HF/MCC will be expected to participate in the exergaming intervention and the investigator-developed modules. Caregivers will be asked to be present for all training sessions and participate in the investigator-developed modules. The investigators will evaluate pre- and post-surgical frailty, fatigue, affective well-being, and immune function as primary outcomes in the individuals with advanced HF/MCC. The investigators expect that participation in low intensity exergaming will improve these primary outcomes pre- and post-surgically, and decrease post-surgical complications and health care utilization. Relationships will be examined among self-efficacy, self-regulation, and activation scores over time, and adherence to the intervention to test whether self-management mechanisms were effective in promoting adherence. Additionally, post-intervention qualitative interviews will be conducted to assess participant and caregiver experiences with the intervention.
Specific aims of this study are the following:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 19 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- 未提供
排除标准
- 未提供
结局指标
主要结局
Change in Functional Capacity from Baseline
时间窗: Baseline, 1 month post-intervention, 1 & 3 months post-surgery
Functional capacity will be assessed with a six-minute walk test. Subjects will be asked to walk for 6 min to determine what distance they can accomplish in that time period at a normal walking pace.
Change in Fatigue from Baseline
时间窗: Baseline, 1 month post-intervention, 1 & 3 months post-surgery
Fatigue will be assessed with the NINR Fatigue Common Data Element which is a 6-item self-report 5-item Likert scale. Higher scores indicate greater feelings of fatigue. Max score is 30.
Change in Physical Frailty from Baseline
时间窗: Baseline, 1 month post-intervention, 1 & 3 months post-surgery
Physical frailty will be assessed using the Fried criteria which include: Unintentional weight loss (10 lbs in past year), exhaustion, weakness (grip strength), slow walking speed, and low physical activity (0 criteria-not frail; 1-2 criteria-pre-frail; ≥3-frail)
次要结局
- Change in Immune Function from Baseline(Baseline, 1 month post-intervention, 1 & 3 months post-surgery)