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.
Bibliographical noteFunding Information:
International Standard Randomised Controlled Trial Registration Number 13860094. We thank the participating patients without whom this sub‐study would not have been possible. We also thank those who made a valuable contribution to the study but are not named as authors, especially the cardiac rehabilitation and research nurse teams at South Tees NHS Foundation Trust. In particular, C. Neave, L. Whitehouse, K. Ainsworth, L. Sarginson, B. Honeymam, Y. Walker, S. Lewis, A. Holden, F. Wanless, T. Hauxwell and L. Metson. We would also like to acknowledge the support of the NIHR Clinical Research Network. This study was funded by the Heart Research UK Translational Research Grant (project ref. RG2671/18/20). The views expressed are those of the authors and do not necessarily reflect those of HRUK. SH, EA, RM, MB and HH report grants from the National Institute for Health and Care Research, Heart Research UK, British Heart Foundation and the Sir Bobby Robson Foundation, during the conduct of this trial. No other competing interests declared.
© 2023 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.