Finding value with prehabilitation in older persons receiving surgery

Ng, Priscilla; Lee, Jin Keat Daniel; Tan, Kok‐Yang

doi:10.1097/spc.0000000000000581

Cited by 5 publications

(6 citation statements)

References 42 publications

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“… n.a. Degenerative spine disease Complex spine surgery Compares multiple assessments Not defined Ng et al [ 51 ] Review article n.a. n.a.…”

Section: Resultsmentioning

confidence: 99%

“…• enacts “miscommunication and misaligned goals among the healthcare team and lack of commitment among the patients”([ 51 ], p. 21),…”

Section: Resultsmentioning

confidence: 99%

“…Multimodal prehabilitation is a resource-intensive intervention [ 34 , 50 , 51 , 56 ]. The resource intensity is determined by the degree of support a patient needs to complete the program and if it is a home-based or centre-based intervention.…”

Section: Resultsmentioning

confidence: 99%

“…The adoption of prehabilitation programmes into the perioperative trajectory depends on a multidisciplinary and interprofessional team approach, because such an intervention among frail and multimorbid patients requires a holistic approach to adequately address their needs [ 51 ]. Only if all involved healthcare professionals have the same understanding of the way prehabilitation should be integrated into the health care setting and the intervention is perceived as valuable by all players, can patients benefit from well-integrated, multimodal care that produces the best outcomes [ 26 ].…”

Section: Resultsmentioning

confidence: 99%

“…Information on funding and conflict of interest can be found in Appendix H . Six of the included documents declared that there was no funding and no conflict of interest to report [ 26 , 38 , 51 , 53 , 56 , 61 ]. Six documents did not report their funding and potential conflict of interest and should be considered with caution [ 32 , 35 , 39 , 41 , 62 , 63 ].…”

Section: Resultsmentioning

confidence: 99%

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Facilitators and barriers to the implementation of prehabilitation for frail patients into routine health care: a realist review

Sontag,

Kiselev,

Schaller

et al. 2024

BMC Health Serv Res

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Background Despite evidence supporting the effectiveness of prehabilitation as a new preoperative care pathway to optimise perioperative outcomes, its implementation into routine health care is widely pending. Frail patients might particularly benefit from prehabilitation interventions, but facilitating and hindering factors need to be considered in the implementation process. Thus, our aim was to derive a programme theory on what prehabilitation programmes work for frail patients in what circumstances and why. Methods Following Pawson’s realist review approach, preliminary programme theories on facilitators and barriers were established. General and topic-specific databases were searched systematically for facilitators and barriers to the implementation of prehabilitation for frail patients. Articles were included if they dealt with multimodal prehabilitation programmes prior to surgery in a frail population and if they contained information on facilitators and barriers during the implementation process in the full text. Based on these articles, refined programme theories were generated. Results From 2,609 unique titles, 34 were retained for the realist synthesis. Facilitating factors included the individualisation of prehabilitation programmes to meet the patients’ needs and abilities, multimodality, adaption to the local setting and health care system, endorsement by an ambassador and sharing of responsibilities among a multidisciplinary team. Central barriers for frail patients were transportation, lack of social support, and inadequate, overwhelming information provision. Conclusions Implementing prehabilitation as a new care pathway for frail patients requires organisational readiness and adaptability to the local setting. On an individual level, a clear understanding of responsibilities and of the intervention’s goal among patients and providers are necessary. Added attention must be paid to the individualisation to fit the needs and restrictions of frail patients. This makes prehabilitation a resource-intense, but promising intervention for frail surgery patients. Trial registration PROSPERO (CRD42022335282).

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“… n.a. Degenerative spine disease Complex spine surgery Compares multiple assessments Not defined Ng et al [ 51 ] Review article n.a. n.a.…”

Section: Resultsmentioning

confidence: 99%

“…• enacts “miscommunication and misaligned goals among the healthcare team and lack of commitment among the patients”([ 51 ], p. 21),…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Facilitators and barriers to the implementation of prehabilitation for frail patients into routine health care: a realist review

Sontag,

Kiselev,

Schaller

et al. 2024

BMC Health Serv Res

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Barriers and facilitators to the implementation of prehabilitation for elderly frail patients prior to elective surgery: a qualitative study with healthcare professionals

Fuchs,

Pfab,

Kiselev

et al. 2024

BMC Health Serv Res

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Background Prehabilitation aims to enhance functional capacity before surgery, minimise complications and achieve a better postoperative outcome. This can be particularly useful for older, frail patients to better tolerate surgery. The aim of this study was to identify what barriers and facilitators healthcare professionals in Germany experienced in the implementation and delivery of the multimodal prehabilitation programme “PRAEP-GO” for (pre-)frail adults aged 70 years and older to inform the implementation of prehabilitation into standard care. Methods A nested descriptive qualitative study was conducted using semi-structured face-to-face interviews with healthcare professionals involved in the PRAEP-GO trial from the Berlin and Brandenburg region in Germany. Transcripts were analysed using Kuckartz’ qualitative content analysis. Results were interpreted and synthesised using the Consolidated Framework for Implementation Research, a theoretical framework to allow their application to a more general context. Results A total of 14 interviews were conducted. Seven therapists (physio-, ergo-, sports therapy), five physicians and two employees from other professions with mainly administrative and organisational tasks in the project. All identified barriers and facilitating factors could be assigned to the themes of organisation, prehabilitation, cooperation and communication between healthcare professionals and with patients. Much optimisation potential was found regarding organisational aspects, e.g. addressing perceived staff shortages and optimising the patient pathway. Furthermore, it became apparent that communication and cooperation between professionals but also with patients need to be improved. More evidence regarding prehabilitation should be provided to convince professionals more. Prehabilitation should be multimodal and individualised, including the programme duration. Officially introducing prehabilitation into standard care would facilitate its delivery. Discussion These findings underscore the fact that successful implementation of prehabilitation programmes, such as PRAEP-GO, requires sufficient organisational infrastructure, human resources, access to knowledge, an adaptable and individualised programme design as well as good communication among professionals and with patients. The transferability of the findings is limited by the absence of nutritionists and resulting overrepresentation of other therapists in the sample. To further convince professionals and patients of the concept of prehabilitation, more research is needed to build a solid evidence base that will ensure greater awareness and, thus, more motivation and cooperation among professionals and patients. Trial registration Open Science Framework (osf.io/ksfgj).

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Cost-effectiveness of prehabilitation prior to elective surgery: a systematic review of economic evaluations

Rombey,

Eckhardt,

Kiselev

et al. 2023

BMC Med

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Background Prehabilitation aims at enhancing patients’ functional capacity and overall health status to enable them to withstand a forthcoming stressor like surgery. Our aim was to synthesise the evidence on the cost-effectiveness of prehabilitation for patients awaiting elective surgery compared with usual preoperative care. Methods We searched PubMed, Embase, the CRD database, ClinicalTrials.gov, the WHO ICTRP and the dissertation databases OADT and DART. Studies comparing prehabilitation for patients with elective surgery to usual preoperative care were included if they reported cost outcomes. All types of economic evaluations (EEs) were included. The primary outcome of the review was cost-effectiveness based on cost–utility analyses (CUAs). The risk of bias of trial-based EEs was assessed with the Cochrane risk of bias 2 tool and the ROBINS-I tool and the credibility of model-based EEs with the ISPOR checklist. Methodological quality of full EEs was assessed using the CHEC checklist. The EEs’ results were synthesised narratively using vote counting based on direction of effect. Results We included 45 unique studies: 25 completed EEs and 20 ongoing studies. Of the completed EEs, 22 were trial-based and three model-based, corresponding to four CUAs, three cost-effectiveness analyses, two cost–benefit analyses, 12 cost–consequence analyses and four cost-minimization analyses. Three of the four trial-based CUAs (75%) found prehabilitation cost-effective, i.e. more effective and/or less costly than usual care. Overall, 16/25 (64.0%) EEs found prehabilitation cost-effective. When excluding studies of insufficient credibility/critical risk of bias, this number reduced to 14/23 (60.9%). In 8/25 (32.0%), cost-effectiveness was unclear, e.g. because prehabilitation was more effective and more costly, and in one EE prehabilitation was not cost-effective. Conclusions We found some evidence that prehabilitation for patients awaiting elective surgery is cost-effective compared to usual preoperative care. However, we suspect a relevant risk of publication bias, and most EEs were of high risk of bias and/or low methodological quality. Furthermore, there was relevant heterogeneity depending on the population, intervention and methods. Future EEs should be performed over a longer time horizon and apply a more comprehensive perspective. Trial registration PROSPERO CRD42020182813.

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Finding value with prehabilitation in older persons receiving surgery

Cited by 5 publications

References 42 publications

Facilitators and barriers to the implementation of prehabilitation for frail patients into routine health care: a realist review

Facilitators and barriers to the implementation of prehabilitation for frail patients into routine health care: a realist review

Barriers and facilitators to the implementation of prehabilitation for elderly frail patients prior to elective surgery: a qualitative study with healthcare professionals

Cost-effectiveness of prehabilitation prior to elective surgery: a systematic review of economic evaluations

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