Frailty, Strength, and Mobility in Older Hernia Patients: A Novel Abdominal Wall Physical Therapy Program
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PROJECT SUMMARY ABSTRACT The Frailty, Strength, and Mobility in Older Hernia Patients: A Novel Abdominal Wall Physical Therapy Program study aims to understand the role of frailty to surgical outcomes and postoperative quality of life (QOL) for older adults undergoing elective abdominal hernia repair (AHR). Additionally, we seek to evaluate the feasibility and utility of a novel perioperative abdominal wall physical therapy (AWPT) for AHR patients over 65. Current literature is scarce on the relationship of frailty to long-term postoperative outcomes in older AHR patients and, crucially, no studies describe peri-operative QOL changes in older hernia patients despite the fact that it is a key consideration for AHR patients and their surgeons. Because of the profound influence QOL gains have on the surgical decision making process, and with the rapid aging of the hernia patient population, we believe that understanding the relationship of frailty to QOL outcomes after AHR is essential. We will undertake a retrospective review of prospectively collected data from a national registry of AHR patients to assess the effect of frailty on patient-reported QOL, as well as standard postoperative outcomes (such as morbidity, mortality, complications, readmissions) for AHR patients over the age of 65 (Aim 1). We hypothesize that increasing frailty will confer a dose-dependent risk of adverse outcomes following AHR, as well as an inverse relationship with quality of life gains. We believe these results may be used in the future to develop surgical decision making tools for older patients considering elective AHR. Pre-surgical optimization is especially important in older, frail patients who decide to undergo operative interventions such as AHR. To that end, we propose to pilot test a novel abdominal wall physical therapy (AWPT) program in a cohort of older patients undergoing elective AHR at a major tertiary care center (Aim 2). Hernia patients over the age of 65 will be offered enrollment in an AWPT program consisting of both home exercises and in-person physical therapy. We will utilize validated measures to assess the effect of AWPT on both strength (Timed Up and Go Test, Sit to Stand Test) and mobility (Life Space Assessment) in AHR patients before and after surgery. We will also use semi-structured interviews to explore older AHR patients’ perspectives on the feasibility and utility of AWPT. We believe that at the completion of this study we will have a better understanding of how frailty affects QOL gains after AHR and, additionally, will be able to utilize our AWPT pilot data to undertake a larger trial examining the effects of peri- operative AWPT on outcomes after AHR in an older cohort.
