Pilot Trial of Abdominal Core Rehabilitation To Improve Outcomes After Ventral Hernia Repair (ABVENTURE-P)

This study aims to evaluate the potential role of physical therapy in improving outcomes after ventral hernia repair.

After being informed about the study and potential risks, all patients giving written informed consent will perform assessments of several activities of daily living and complete several surveys detailing their pre-surgical abilities, quality of life, and pain. Immediately after their surgical procedure, patients will be randomized in a single-blind manner (investigator) in a 1:1 ratio to supervised physical therapy (8 weeks, twice weekly) or standard post-surgical precautions. Assessments and surveys will be repeated by the blinded investigator at 30 days, 10 weeks, 6 months, and 1 year after surgery.

Ventral Hernia, Hernia, Herniorrhaphy, Abdominal Wall, Postoperative Period, Physical Therapy Modalities

Participants in the control group will be told upon post-operative discharge that they should follow the post-operative instructions.

Participants in the physical therapy group will be scheduled for visits to the physical therapy clinic beginning two weeks after surgery, and will undergo supervised physical therapy treatments approximately twice per week for eight weeks according to a standardized evidence-based post-operative abdominal core surgery rehabilitation program.

The twice-per-week 8-week course of supervised physical therapy begins 2 weeks after surgery. It targets abdominal core function through progressive muscle retraining and strengthening, and patient-specific posture and body mechanics education.

This intervention includes standard of care post-operative instructions typically given to patients undergoing ventral hernia repair across the world. These include limiting strenuous physical activity and a lifting restriction of no more than 10 pounds for 6 weeks. Binder use is also encouraged for 4-6 weeks after the operation.

From a standard chair, stand and sit back down five times in immediate succession as quickly as possible.

Change from Baseline in Patient-Reported Outcomes Measurement Information System (PROMIS) - Physical Function

Sit on an inflated cushion that creates an unstable surface for 60 seconds with eyes closed and arms crossed while counting to a metronome.

Patient-reported questionnaire asking questions about abdominal wall function including activities of daily living, independent mobility, and mental health.

Starting seated in a standard chair, stand, walk forward 3 m, turn 180 deg, walk back to chair, sit down. Do all of these as quickly as can be done safely.

Self-reported physical activity questions spanning sedentary behavior, job activity, transportation activity, household activity, and recreational activity.

Patient-reported questionnaire asking questions regarding a recurrence of the hernia based on pain and presence of a physical bulge.

Patient-reported questionnaire asking questions about abdominal wall function including activities of daily living, independent mobility, and mental health.

Starting seated in a standard chair, stand, walk forward 3 m, turn 180 deg, walk back to chair, sit down. Do all of these as quickly as can be done safely.

Self-reported physical activity questions spanning sedentary behavior, job activity, transportation activity, household activity, and recreational activity.

From a standard chair, stand and sit back down five times in immediate succession as quickly as possible.

Change from Baseline in Patient-Reported Outcomes Measurement Information System (PROMIS) - Physical Function

Sit on an inflated cushion that creates an unstable surface for 60 seconds with eyes closed and arms crossed while counting to a metronome.

Patient-reported questionnaire asking questions about abdominal wall function including activities of daily living, independent mobility, and mental health.

Starting seated in a standard chair, stand, walk forward 3 m, turn 180 deg, walk back to chair, sit down. Do all of these as quickly as can be done safely.

Self-reported physical activity questions spanning sedentary behavior, job activity, transportation activity, household activity, and recreational activity.

From a standard chair, stand and sit back down five times in immediate succession as quickly as possible.

Change from Baseline in Patient-Reported Outcomes Measurement Information System (PROMIS) - Physical Function

Sit on an inflated cushion that creates an unstable surface for 60 seconds with eyes closed and arms crossed while counting to a metronome.

Patient-reported questionnaire asking questions about abdominal wall function including activities of daily living, independent mobility, and mental health.

Starting seated in a standard chair, stand, walk forward 3 m, turn 180 deg, walk back to chair, sit down. Do all of these as quickly as can be done safely.

Self-reported physical activity questions spanning sedentary behavior, job activity, transportation activity, household activity, and recreational activity.

From a standard chair, stand and sit back down five times in immediate succession as quickly as possible.

Change from Baseline in Patient-Reported Outcomes Measurement Information System (PROMIS) - Physical Function

Sit on an inflated cushion that creates an unstable surface for 60 seconds with eyes closed and arms crossed while counting to a metronome.

Inclusion Criteria Ages 18+ Diagnosis of ventral hernia Scheduled for elective ventral hernia repair Independent functional status Transverse hernia width of 2cm or greater Exclusion Criteria Previously diagnosed movement or balance disorder Use of ambulatory assistive device (walker or cane) Not currently undergoing or planning to undergo physical therapy or other skilled exercise intervention supervised by a medical rehabilitation professional