Multicomponent Prehabilitation as a Novel Strategy for Preventing Delirium in Older Chronic Limb Threatening Ischemia Patients: A Study Protocol

Figures & data

Table 1 Overview of the Study

			Time Point, Study Period
			Outpatient Clinic	MVE	MM	During Admission	Discharge	6m	12m
Care Worker	Population	Action/test		T0		T1	T2	T3	T4
Vascular surgeon	All patients	Diagnosis	x
		Request additional imaging	x
	All CLTI patients > 65 years	Referral to MVE	x
		Definitive treatment plan			x
Start PETRI-study
Biochemistry tests^a			x			x
VNP	All patients	Written informed consent	x
		Baseline characteristics	x
		Vital functions	x			x	x
		Fall screening	x
		KATZ-ADL	x
		ISAR-HP	x
		SNAQ-RC	x
		MMSE	x
		G8	x
		V-possum	x
		ASA-score	x
		Charlson comorbidity index	x
		Check for delirium	x			x	x
Physiotherapist	All patients	MIP	x
		DEMMI	x
		Grip strength	x
		TUG	x
		TCS	x
		10MWT	x
		Home exercises^b	x
*Dietician	All patients with: - SNAQ-RC >3 - Unintentional weight loss - low protein intake	MNA-SF	x
		SNAQ-RC	x
		BMI	x			x
		*Dietary advise	*x
		*Nutridrink	*x
*Geriatrician	All patients with: -MMSE < 26 -TUG > 14 sec -Previous delirium -Polypharmacy >4 -Alcohol > 7 units/week -G8 < 15	CGA	x
		*Delirium preventive measures	*x			*x
		*Prescribe supplementary vitamins	*x
Patients with nicotine use		*Quit smoking coach	x
Patients with anaemia^c		*FERINJECT iron infusion^d	x
*Needs-assessment for nursing care		- Expected problems after discharge - Caregiver (burden)	x
Questionnaires	All patients	WHOQOL-BREF	x					x	x
		Mastery	x
		SF-12	x					x	x
		VascuQoL-6-NL	x					x	x
		Caregiver Strain Index	x					x	x
		HADS	x
		Process analysis				x
		Daily diary for exercises	x

Notes: All italicized terms, marked with * are optional; criteria are described in the row following the corresponding term. ^aConsisting of: haemoglobin, haematocrit, MCV, C-Reactive Protein, leukocytes, thrombocytes, liver enzymes (ASAT, ALAT), electrolytes (sodium, potassium, chloride), MDRD, urea, creatinine, INR, lipid spectrum including cholesterol, vitamin D, vitamin B12, folium acid, transferrin, ferritin. ^bTailor-made home exercises including walking, muscle exercises. ^cDefinition anaemia: haemoglobin <8.1 mmol/L (Male), <7.4 mmol/L (Female). ^d1000mg intravenous Ferinject (ferric carboxymaltose) in 15 minutes during day care admission.

Abbreviations: 6m, 6 months; 12m, 12 months; MVE, Multidisciplinary Vascular surgical outpatient clinic for the Elderly; MM, Multidisciplinary meeting; CLTI, Chronic Limb Threatening Ischemia; VNP, Vascular Nurse Practitioner; KATZ-ADL, Katz index of Independence in Activities of Daily Living; ISAR-HP, Identification of Seniors at Risk – Hospitalized Patients; SNAQ-RC, Short Nutritional Assessment Questionnaire for Residential Care; MMSE, Mini-mental state examination; G8, Geriatric 8 (frailty score); V-possum, Vascular-Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity; ASA, American Society of Anaesthesiology Score; MIP, Maximal Inspiratory Pressure; DEMMI, The de Morton Mobility Index; TUG, Time Up and Go; TCS, Time Chair Stand; 10MWT, 10 meter Walking Test; MNA-SF, Mini Nutritional Assessment Short-Form; BMI, Body Mass Index; CGA, Comprehensive Geriatric Assessment; WHOQOL-BREF, World Health Organization Quality of Life Brief Version; SF-12, Short Form Health Survey; VascuQoL-6-NL, Vascular Quality of Life-6-NL.