Is referral of postsurgical colorectal cancer survivors to cardiac rehabilitation feasible and acceptable? A pragmatic pilot randomised controlled trial with embedded qualitative study

Abstract

Objectives(1) Assess whether cardiac rehabilitation (CR) is a feasible and acceptable model of rehabilitation for postsurgical colorectal cancer (CRC) survivors, (2) evaluate trial procedures. This article reports the results of the first objective.Design and settingA pragmatic pilot randomised controlled trial with embedded qualitative study was conducted in 3 UK hospitals with CR facilities. Descriptive statistics were used to summarise trial parameters indicative of intervention feasibility and acceptability. Interviews and focus groups were conducted and data analysed thematically.ParticipantsPeople with CRC were considered for inclusion in the trial if they were ≥18 years old, diagnosed with primary CRC and in the recovery period postsurgery (they could still be receiving adjuvant therapy). 31% (n=41) of all eligible CRC survivors consented to participate in the trial. 22 of these CRC survivors, and 8 people with cardiovascular disease (CVD), 5 CRC nurses and 6 CR clinicians participated in the qualitative study.InterventionReferral of postsurgical CRC survivors to weekly CR exercise classes and information sessions. Classes included CRC survivors and people with CVD. CR nurses and physiotherapists were given training about cancer and exercise.ResultsBarriers to CR were protracted recoveries from surgery, ongoing treatments and poor mobility. No adverse events were reported during the trial, suggesting that CR is safe. 62% of participants completed the intervention as per protocol and had high levels of attendance. 20 health professionals attended the cancer and exercise training course, rating it as excellent. Participants perceived that CR increased CRC survivors’ confidence and motivation to exercise, and offered peer support. CR professionals were concerned about CR capacity to accommodate cancer survivors and their ability to provide psychosocial support to this group of patients.ConclusionsCR is feasible and acceptable for postsurgical CRC survivors. A large-scale effectiveness trial of the intervention should be conducted.Trial registration numberISRCTN63510637.

Art participation for psychosocial wellbeing during stroke rehabilitation: a feasibility randomised controlled trial

“…Despite this, change in Social Participation was greater for the intervention group, suggesting as reported elsewhere, that art participation may enhance well-being via social interaction 14,17,[43][44][45] . A definitive trial, randomising by clusters would ensure sufficient participants at individual sites to conduct group sessions.…”

“…Hope predicts recovery after stroke 36 . The Trait Hope Scale reflects hope of achieving broader life goals, an outcome that was attributed to art participation in previous research 17 . It is a 12-item measure with four item Lickert subscales of agency and pathway.…”

“…A person-centred arts participation programme developed collaboratively with artists, academics and stroke survivors has been routinely delivered within a Scottish health board. A qualitative study with three artists who delivered that programme, and eleven previous participants 17 showed the programme enhanced perceptions of hope, selfefficacy and perceived control over recovery as central components of enhanced wellbeing. Other benefits included physical and communication recovery, self-esteem and positive emotional state.…”

“…Other benefits included physical and communication recovery, self-esteem and positive emotional state. These benefits were operationalised using standardised outcome measures congruent with models of wellbeing, as described within the intervention model identified in preliminary work to model the intervention 17 . The qualitative work facilitated modelling of the existing intervention into a protocol for use in an RCT, which was tested in a feasibility RCT.…”

“…Art making appeared to develop confidence to achieve art-specific goal achievement and personal rehabilitation goals 14,17 . To capture this general confidence, the General Self-Efficacy Scale 37 was selected, a 10-item scale assessing confidence to deal with life demands.…”