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Table 2 Summary of intervention details and length of follow-up

From: Supportive interventions to improve physiological and psychological health outcomes among patients undergoing cystectomy: a systematic review

Intervention type Author and date Recruitment and setting Perioperative stage and delivery Intervention content Intervention time, duration, frequency Length of follow-up
Exercise therapy Banerjee et al., 2017 [14] Patients recruited from a single hospital. Supervised intervention setting. Preoperative intervention delivered by exercise science staff Short-term preoperative vigorous intensity aerobic interval exercise on a cycle ergometer using the Borg Ratings of Perceived Exertion (RPE) Scale to control intensity. 5–10 warm up against light resistance (50 W), patients aimed to perform 6 × 5 min intervals to a target perceived exertion of 13–15 (somewhat hard to hard equating to 70–85% predicted max heart rate based on 220-age, with 2.5 min interpolated active rest intervals against light resistance (50 W). Instructed to maintain a steady pedalling cadence of 50–60 rev min-1 during intervals, and the exercise programme was progressed gradually adding more load to the flywheel to maintain the target perceived exertion. Followed by cool down against low resistance (50 W). 5–10 warm up.6 × 5 min intervals with 2.5 min interpolated active rest intervals. Twice weekly over preoperative period until surgery (3–6 weeks). Minimum of six sessions performed. Until discharge
Jensen, Jensen et al., 2014 [18] Patients recruited from a single hospital. Combined hospital and home-based intervention setting Pre- and postoperative intervention delivered by physiotherapists Preoperative standardised exercise training programme at home; step training on a step trainer and muscle strength and endurance exercises. Postoperative mobilisation and rehabilitation; instructions for getting out of bed, mobilisation and walking.
Exercise-based rehabilitation in the hospital; respiratory and circulatory exercises, mobilisation, walking, supervised standardised progressive muscle strength and endurance training. Patients discharged with a home training exercise programme.
Preoperative 15 min step training and daily exercise programme consisting of six different exercises with individualised repetitions twice-daily.
Postoperative mobilisation and exercise-based rehabilitation for 30 min twice-daily for the first seven postoperative days.
Day 35 and 4 months postoperatively
Jensen, Petersen et al., 2015 [20]
Jensen, Laustsen et al., 2016 [19]
Porserud et al., 2014 [21] Patients recruited from a single hospital. Combined hospital and home-based intervention setting Postoperative intervention delivered by physiotherapists Postoperative group exercise training programme in the hospital; lower body strength and endurance training; walking and strengthening exercises, balance training, mobility training and stretching exercises. Music was used as inspiration. Participants were also instructed to take walks at a self-selected pace. 45 min twice a week for 12 weeks.
Walks at a self-selected pace, 3–5 days a week for at least 15 min.
14 weeks and 1 year postoperatively
Pharmaceutical Ghoneim & Hegazy 2013 [22] Recruitment setting not reported. Hospital based intervention Preoperative intervention. Deliverer not reported 75 mg pregabalin orally. 2× day for 10 days prior to operation. 48 h postoperatively
Lee et al., 2014 [16] Patients recruited from multiple centres. Hospital based intervention Pre- and postoperative intervention. Deliverer not reported 12 mg alvimopan before surgery and twice-daily doses postoperatively. Single dose (12 mg) between 30 min and 5 h before surgery and twice-daily doses postoperatively until hospital discharge or a maximum of 7 days (15 in-hospital doses). Until discharge and 30 days after discharge
Mohamed et al., 2016 [23] Patients recruited from single hospital. Hospital based intervention Preoperative delivered by staff nurse Group 2300 mg pregabalin orally 2 h preoperative
Group 3300 mg pregabalin orally 2 h preoperative and 12 h thereafter
Group 4600 mg pregabalin orally 2 h preoperative
  24 h postoperatively
Fast-track/ERAS protocol Frees et al., 2017 [25] Patients recruited from single hospital. Hospital based intervention Perioperative intervention. Deliverer not reported. ERAS protocol (see original study for details). Perioperative until discharge. 30 days postoperatively
Karl et al., 2014 [24] Recruitment setting not reported. Hospital based intervention Perioperative intervention. Deliverer not reported ERAS protocol (see original study for details). Perioperative until discharge. Day 3, day 7 postoperatively and until discharge
Olaru et al., 2015 [17] Patients recruited from a single hospital. Hospital based intervention Perioperative intervention delivered by healthcare professionals ERAS protocol (see original study for details). Perioperative until discharge. Until discharge
Psychological/educational Ali et al., 1989 [12] Patients recruited from a single hospital. Hospital based intervention Preoperative intervention. Deliverer not reported Single, preoperative psychoeducational session provided to the patient and a significant other. Included explanation of the surgical procedure, site and appearance of stoma, device to be used postoperatively, reasons for wearing a collection device, and a visit from another “ostomate” who is functioning well. Patients encouraged to express fears and anxieties regarding social aspects of living with a stoma, including clothing, changes in body image, sexuality, exercise, activity, and odour. 1 × 30–60 min session. Until discharge (approx. 12 days postoperatively)
Jensen, Kiesbye et al., 2017 [13] Patients recruited from a single hospital. Combined hospital and home-based intervention setting Pre- and postoperative intervention delivered by Urological Enteral Stoma
Therapy Nurses
The education programme included basic skills to optimise the ability to perform independent stoma care. Patients encouraged to perform stoma care and change of appliance, both one-piece and two-piece system, at least twice at home providing them with training kits and appliances. The patient was educated about the urostomy and life with a urostomy related to the individual patient’s life and life style. Every patient had a follow up prior to surgery where the Urological Enteral Stoma Therapy Nurse observed self-care skills regarding stoma care and change of appliance. 1 x education programme under supervision, 2 x practice at home, 1 x self-demonstration under observation prior to surgery. Day 35 and 4 months and 12 months postoperatively
Mansson et al., 1997 [1] Recruitment setting not reported. Home based intervention Postoperative intervention. Deliverer not reported Psychosocial programme including weekly counselling, in the patient’s home for 4 weeks, and thereafter by telephone. The discussion concerned consequences of the operation, practical and emotional problems, influences on mood and relations to partner and friends. The partner could be present at the interview. Weekly counselling for 4 weeks then via telephone for 2 weeks. 3 months and 6 months postoperatively
Merandy et al., 2017 [15] Patients recruited from a single hospital. Hospital based intervention Postoperative day 4, 5 or 6 delivered by trained nurse practitioners Multimethod educational intervention was developed for each of the three different urinary diversions and included (a) a simplified medical illustration of participant-specific urinary diversion, (b) a step-by-step urinary diversion self-care instructional video, and (c) a pictorial Microsoft PowerPoint®. The content was driven by Bandura’s (1977) four sources of self-efficacy and were based on first-hand observed difficulties experienced by patients with a urinary diversion. The video, PowerPoint, illustrations, and surveys were administered at the bedside by one of the investigators using a tablet computer. The intervention was enhanced by professional demonstration, followed by a chance for return demonstration. 1 × 1 h in duration, with an optional 30 min for participant questions Immediately after intervention
Chewing gum Choi et al., 2011 [26] Patients recruited from a single hospital. Hospital based intervention Postoperative intervention delivered by study investigators Sugar-free chewing gum. 30 min chewing three times daily at 10 am, 3 pm and 8 pm until first flatus. Discharge. Short term complications within 30 days
Nutritional Deibert et al., 2016 [28] Patients recruited from 2 hospital centres. Hospital based intervention. Postoperative intervention. Deliverer not reported Clear liquid diet on postoperative day 1 and access to a full regular diet from postoperative day 2 and beyond. Postoperative until discharge 90 days postoperatively
Roth et al., 2013 [27] Patients recruited from a single hospital. Hospital based intervention Postoperative intervention delivered by hospital ward staff Total parenteral nutrition (TPN). Nutriflex special; a solution with a total energy of 1240 kcal/1000 ml and containing polyamino acids, glucose, and electrolytes. An additional 30 IU Actrapid HM and 1875 IU heparin per 24 h were added to the TPN solution. Administered continuously for 5 days starting on postoperative day 1. 1, 3, 7, 12 days postoperatively and complications up to 30 days postoperatively
Vidal et al., 2016 [29] 3, 6, 12, 18, 24, 30 and 36 months postoperatively
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