S. L. Harrison's research while affiliated with Teesside University and other places

Introduction People with chronic obstructive pulmonary disease (COPD) have balance impairment and fall more frequently than healthy peers. Exercise is a key component in improving balance, yet the effect of different exercise-based interventions remains unclear. This systematic review aimed to investigate the mean treatment effect of exercise-based interventions on balance and falls in people with COPD. Methods Eight databases were searched in August 2021 (updated January 2023). Studies involving; exercise-based interventions (including pulmonary rehabilitation (PR)) delivered for a minimum 14 days to people with COPD; balance or falls outcomes; with an immediate post-intervention primary endpoint were included. RoB2 or ROBINS-I assessed risk of bias. Pooled effect sizes and 95% confidence intervals were calculated for outcomes reported in five or more studies. Exploratory meta-regression and narrative synthesis were also undertaken. Results Deduplicated searches returned 1349 studies of which n=34 (n= 1712 participants) were included (RCT n=19, non-RCT n=1, pre-post study n=14). Overall, risk of bias was moderate. Random effects meta-analysis (figure 1) indicated greater improvements following exercise-based interventions compared to usual care in; Berg Balance Scale (BBS, n=9) μ=2.52 (95% CI: 0.22 to 4.82); Timed Up and Go (TUG, n=10) μ =-1.11 (95% CI: -1.68 to -0.54); Single Leg Stance (SLS, n=6) μ=3.41 (95% CI: 2.70 to 4.13) and Activities Balance Confidence Scale (ABC, n=6) μ=8.56 (95% CI: 2.44 to 14.67. Narrative synthesis described improvements in BBS, TUG and SLS, plus Tinetti, Functional Reach, Balance Evaluation Systems Test, posturography and Elderly Fall Screening Test.Meta-regression observed a superior treatment effect in all male vs mixed-sex groups for ABC (μ= 12.8, t(4) = 5.5, p <.01, (6.38– 19.23)). Falls history was not associated with changes in balance but studies including balance training with PR were more beneficial at improving BBS and TUG (μ= 4.35, t(7) = 2.73, p = .03, 95% CI (0.58 – 8.1), -1.16, t(8) = -6.21, p<0.01, the 95% CI (-1.6 – 0.7) respectively). • Download figure • Open in new tab • Download powerpoint Abstract P29 Figure 1 Meta-analysis results a) BBS b) TUG c) SLS d) ABC Discussion Broad treatment effects make it difficult to conclude any benefit of exercise-based interventions on balance and falls in people with COPD. However, findings suggest inclusion of targeted balance training may derive the greatest benefits.

The feasibility, safety and efficacy of prehabilitation in adult patients awaiting elective cardiac surgery are unknown. A total of 180 participants undergoing elective cardiac surgery were allocated randomly to receive either standard pre-operative care or prehabilitation, consisting of pre-operative exercise and inspiratory muscle training. The primary outcome was change in six-minute walk test distance from baseline to pre-operative assessment. Secondary outcomes included change in inspiratory muscle strength (maximal inspiratory pressure); sarcopenia (handgrip strength); quality of life and compliance. Safety outcomes were pre-specified surgical and pulmonary complications and adverse events. All outcomes were assessed at baseline; at pre-operative assessment; and 6 and 12 weeks following surgery. Mean (SD) age was 64.7 (10.2) years; 33/180 (18%) were women. In total, 65/91 (71.4%) participants who were allocated to prehabilitation attended at least four of eight supervised in-hospital exercise classes; participants aged > 50 years were more likely than younger participants to attend (odds ratio (95%CI) of 4.6 (1.0-25.1)). Six-minute walk test was not significantly different between groups (mean difference (95%CI) -7.8 m (-30.6-15.0), p = 0.503) in the intention-to-treat analysis. Subgroup analyses based on tests for interaction indicated improvements in six-minute walk test distance were larger amongst sarcopenic patients in the prehabilitation group (p = 0.004). Change in maximal inspiratory pressure from baseline to all time-points was significantly greater in the prehabilitation group, with the greatest mean difference (95%CI) observed 12 weeks after surgery (10.6 cmH2 O (4.6-16.6) cmH2 O, p < 0.001). There were no differences in handgrip strength or quality of life up to 12 weeks after surgery. There was no significant difference in postoperative mortality (one death in each group), surgical or pulmonary complications. Of 71 pre-operative adverse events, six (8.5%) were related to prehabilitation. The combination of exercise and inspiratory muscle training in a prehabilitation intervention before cardiac surgery was not superior to standard care in improving functional exercise capacity measured by six-minute walk test distance pre-operatively. Future trials should target patients living with sarcopenia and include inspiratory muscle strength training.

The purpose of this study was to understand the views and experiences of patients enrolled and staff involved in the prehabilitation of elective patients undergoing cardiac surgery trial. This sub-study was informed by normalisation process theory, a framework for evaluating complex interventions, and used consecutive sampling to recruit patients assigned to both the intervention and control groups. Patients and all staff involved in delivering the trial were invited to participate in focus groups, which were recorded, transcribed verbatim and subjected to reflexive thematic analysis. Five focus groups were held comprising 24 participants in total (nine patients assigned to the prehabilitation; seven assigned to control; and eight staff). Five themes were identified. First, preparedness for surgery reduced fear, where participants described that knowing what to expect from surgery and preparing the body physically increased feelings of control and subsequently reduced apprehension regarding surgery. Second, staff were concerned but trusted in a safe environment, describing how, despite staff's concerns regarding the risks of exercise in this population, the patients felt safe in their care whilst participating in an exercise programme in hospital. Third, rushing for recovery and the curious carer, where patients from both groups wanted to mobilise quickly postoperatively whilst staff visited patients on the ward to observe their recovery progress. Fourth, to survive and thrive postoperatively, reflecting staff and patients' expectations from the trial and what motivated them to participate. Fifth, benefits are diluted by lengthy waiting periods, reflecting the frustration felt by patients waiting for their surgery after completing the intervention and the fear about continuing exercise at home before they had been 'fixed'. To conclude, functional exercise capacity may not have improved following prehabilitation in people before elective cardiac surgery due to concerns regarding the safety of exercise that may have hindered delivery and receipt of the intervention. Instead, numerous non-physical benefits were elicited. The information from this qualitative study offers valuable recommendations regarding refining a prehabilitation intervention and conducting a subsequent trial.