Patient acceptance of prehabilitation for major surgery: an exploratory survey

Waterland, Jamie L; Ismail, Hilmy; Amin, Babak; Granger, Catherine L; Denehy, Linda; Riedel, Bernhard

doi:10.1007/s00520-020-05547-1

Cited by 35 publications

(31 citation statements)

References 14 publications

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“…The willingness to participant must also be considered when interpreting findings as recruitment rates varied greatly within included studies and ranged from all patients approached consenting to participate (8) to as high as 65% (12) and 82% (15) of patients approached for inclusion declining to participate in prehabilitation. This acceptance may reflect individual aspects of the program suggested to influence patients waiting for cancer surgery such as delivery location, use of technology and recommendation by health professionals (43).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Prehabilitation Including Exercise on Postoperative Outcomes Following Abdominal Cancer Surgery: A Systematic Review and Meta-Analysis

et al. 2021

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Objectives: This systematic review set out to identify, evaluate and synthesise the evidence examining the effect of prehabilitation including exercise on postoperative outcomes following abdominal cancer surgery.Methods: Five electronic databases (MEDLINE 1946-2020, EMBASE 1947-2020, CINAHL 1937-2020, PEDro 1999-2020, and Cochrane Central Registry of Controlled Trials 1991-2020) were systematically searched (until August 2020) for randomised controlled trials (RCTs) that investigated the effects of prehabilitation interventions in patients undergoing abdominal cancer surgery. This review included any form of prehabilitation either unimodal or multimodal that included whole body and/or respiratory exercises as a stand-alone intervention or in addition to other prehabilitation interventions (such as nutrition and psychology) compared to standard care.Results: Twenty-two studies were included in the systematic review and 21 studies in the meta-analysis. There was moderate quality of evidence that multimodal prehabilitation improves pre-operative functional capacity as measured by 6 min walk distance (Mean difference [MD] 33.09 metres, 95% CI 17.69–48.50; p = <0.01) but improvement in cardiorespiratory fitness such as preoperative oxygen consumption at peak exercise (VO2 peak; MD 1.74 mL/kg/min, 95% CI −0.03–3.50; p = 0.05) and anaerobic threshold (AT; MD 1.21 mL/kg/min, 95% CI −0.34–2.76; p = 0.13) were not significant. A reduction in hospital length of stay (MD 3.68 days, 95% CI 0.92–6.44; p = 0.009) was observed but no effect was observed for postoperative complications (Odds Ratio [OR] 0.81, 95% CI 0.55–1.18; p = 0.27), pulmonary complications (OR 0.53, 95% CI 0.28–1.01; p = 0.05), hospital re-admission (OR 1.07, 95% CI 0.61–1.90; p = 0.81) or postoperative mortality (OR 0.95, 95% CI 0.43–2.09, p = 0.90).Conclusion: Multimodal prehabilitation improves preoperative functional capacity with reduction in hospital length of stay. This supports the need for ongoing research on innovative cost-effective prehabilitation approaches, research within large multicentre studies to verify this effect and to explore implementation strategies within clinical practise.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Prehabilitation Including Exercise on Postoperative Outcomes Following Abdominal Cancer Surgery: A Systematic Review and Meta-Analysis

et al. 2021

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“…Recent research has shown that the majority of patients (72%, 74/103) awaiting major gastrointestinal and urological cancer surgeries would prefer to do a preoperative exercise programme at home. 16 Therefore, there is a need to develop an evidence-based technology to deliver a preoperative exercise programme to patients undergoing surgery that can improve exercise fidelity and patient adherence to exercise regimens when performed at home. We have developed a set of recommendations that we consider important based on our collective experience in preoperative group exercise programmes and technology-based exercise programme design.…”

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Evidence on technology-driven preoperative exercise interventions: are we there yet?

Steffens

Delbaere

Young

et al. 2020

British Journal of Anaesthesia

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“…Waterland et al, 2020 [39] found 72% of patients prior to oncological surgery would prefer exercise prehabilitation in a home-based environment. Although initial work has been done to optimise the homebased service, especially in the wake of the COVID-19 pandemic, further scoping needs to occur involving app-based, web-based, or virtual reality methodologies to improve treatment delity when exercising at home [40].…”

Section: Discussionmentioning

confidence: 99%

Impact of an Allied Health Prehabilitation Service for Haematologic Patients Receiving High Dose Chemotherapy in A Large Cancer Centre

Crowe

Francis

Edbrooke

et al. 2021

Preprint

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Purpose To evaluate the impact of routine multidisciplinary allied health prehabilitation care in haematologic cancer patients receiving high-dose chemotherapy with autologous stem cell transplant (AuSCT). Methods In a tertiary cancer centre, 12-months of prospectively collected data was retrospectively analysed. Patients were referred to the service for individualised exercise prescription, nutrition intervention and, if indicated through screening, psychological intervention. Impact and operational success were investigated based on the RE-AIM framework: patient uptake of the service and sample representativeness (Reach); Effectiveness in terms of changes in outcomes from initial to pre-transplant assessment; Adoption of the service by key stakeholders; fidelity of the prescribed exercise program (Implementation); and the extent to which the service had become part of routine standard care (Maintenance). Results 183 patients were referred to the AuSCT service, of whom 133 (73%) were referred into the prehabilitation service, 128 (96%) were eligible and 116 (91%) participated. Significant improvements were demonstrated between initial and pre-transplant assessments particularly six-minute walk distance (n = 45); mean difference (95% CI) 39.9m (18.8 to 61.0, p = < 0.005). Missing data were an issue for assessment of effectiveness. Fidelity of exercise prescription was moderate with 72% of eligible patients receiving the intended aerobic and resistance exercise interventions. Conclusion The prehabilitation service was well adopted by clinicians. Clinically relevant improvements in outcomes were demonstrated. Recommendations, including development of well-integrated discipline-specific assessment intervention and measurement protocols, are highlighted to improve the service. Prehabilitation should be routinely considered to support the care of patients undergoing AuSCT.

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Patient acceptance of prehabilitation for major surgery: an exploratory survey

Cited by 35 publications

References 14 publications

Efficacy of Prehabilitation Including Exercise on Postoperative Outcomes Following Abdominal Cancer Surgery: A Systematic Review and Meta-Analysis

Efficacy of Prehabilitation Including Exercise on Postoperative Outcomes Following Abdominal Cancer Surgery: A Systematic Review and Meta-Analysis

Evidence on technology-driven preoperative exercise interventions: are we there yet?

Impact of an Allied Health Prehabilitation Service for Haematologic Patients Receiving High Dose Chemotherapy in A Large Cancer Centre

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