Prehabilitation and preparation for surgery: has the digital revolution arrived?

Durrand, James W.; Moore, J. A.; Danjoux, Gerard

doi:10.1111/anae.15622

Cited by 10 publications

(4 citation statements)

References 16 publications

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“…The project continues to improve through digital technology, using activity monitors to incentivise patients and smartphones to disseminate exercise plans. 22 Funding has been secured for biweekly virtual exercise classes which will enable a greater number of patients to participate in ability appropriate physical prehabilitation sessions. These virtual sessions will enable assessment of patients’ functional progress.…”

Section: Discussionmentioning

confidence: 99%

Multimodal prehabilitation service for patients with colorectal cancer: the challenges of implementation

et al. 2023

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Prehabilitation has been shown to improve outcomes for patients undergoing major surgery; benefits include reductions in length of hospital stay and postoperative complications. Multimodal prehabilitation programmes lead to improved patient engagement and experience. This report describes implementation of a personalised multimodal prehabilitation programme for patients awaiting colorectal cancer surgery. We aim to highlight the successes, challenges and future direction of our programme.Patients listed for colorectal cancer surgery were referred for initial prehabilitation assessment. The prehabilitation group were assessed by specialist physiotherapists, dieticians and psychologists. An individualised programme was developed for each patient, aiming to optimise preoperative functional capacity and enhance physical and psychological resilience. Clinical primary outcome measures were recorded and compared with contemporaneous controls. For those undergoing prehabilitation, a set of secondary functional, nutritional and psychological outcomes were recorded at initial assessment and on completion of the programme.61 patients were enrolled in the programme from December 2021 to October 2022. 12 patients were excluded as they received less than 14 days prehabilitation or had incomplete data. The remaining 49 patients received a median duration of 24 days prehabilitation (range 15–91 days). The results show statistically significant improvements in the following functional outcome measures after prehabilitation: Rockwood scores, maximal inspiratory pressures, International Physical Activity Questionnaire Score and Functional Assessment of Chronic Illness - Fatigue Score. There was a lower postoperative complication rate in the prehabilitation group when compared with a control group (50% vs 67%).This quality improvement project has 3 Plan–Do–Study–Act (PDSA) cycles. PDSA 1 demonstrates prehabilitation can be successfully imbedded within a colorectal surgical unit and that patients are grateful for the service. PDSA 2 provides the project’s first complete data set and demonstrates functional improvements in patients undergoing prehabilitation. The third PDSA cycle is ongoing and aims to refine the prehabilitation interventions and improve clinical outcomes for patients undergoing colorectal cancer surgery.

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Section: Discussionmentioning

confidence: 99%

Multimodal prehabilitation service for patients with colorectal cancer: the challenges of implementation

et al. 2023

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“…They have matched face-to-face delivery in supporting behaviour change in other healthcare settings such as cardiac rehabilitation and diabetes management 26. The authors have recently published a proposed framework for delivery of digital prehabilitation, setting out future requirements and strategies for scalable implementation 27. One major concern is the risk of digital exclusion in our target population (predominantly older adults).…”

Section: Introductionmentioning

confidence: 99%

“… 26 The authors have recently published a proposed framework for delivery of digital prehabilitation, setting out future requirements and strategies for scalable implementation. 27 One major concern is the risk of digital exclusion in our target population (predominantly older adults). However, this group is becoming increasingly engaged with digital technology, with 75% of adults aged 65–74 years reporting they regularly use the internet.…”

Section: Introductionmentioning

confidence: 99%

Digital health coaching to improve patient preparedness for elective lower limb arthroplasty: a quality improvement project

Powley,

Tew,

Durrand

et al. 2023

BMJ Open Qual

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Major surgery carries high risks with comorbidities, frailty and health risk behaviours meaning patients are often unprepared for the physiological insult. Since 2018, the Prepwell programme at South Tees Hospitals NHS Foundation Trust has supported patients to improve their preoperative health and fitness. In April 2020, the face-to-face service was suspended due to the pandemic, leading to the team implementing a three-tiered remote digital support pathway, including digital health coaching via a mobile phone application.MethodsPatients scheduled for elective lower limb arthroplasty were offered 8 weeks of digital health coaching preoperatively. Following consent, participants were assigned a personal health coach to set individual behaviour change goals supported by online resources, alongside a digitally delivered exercise programme. Participants completed self-assessment questionnaires at Entry to, and Exit from, the programme, with outcome data collected 21 days postoperatively. The primary outcome was the change in Patient Activation Measure (PAM).ResultsFifty-seven of 189 patients (30.2%) consented to referral for digital health coaching. Forty participants completed the 8-week programme. Median PAM increased from 58.1 to 67.8 (p=0.002). Thirty-five per cent of participants were in a non-activated PAM level at Entry, reducing to 15% at Exit with no participants in PAM level 1 at completion. Seventy-one percent of non-activated participants improved their PAM by one level or more, compared with 45% for the whole cohort. Median LOS was 2 days, 1 day less than the Trust’s arthroplasty patient population during the study period (unadjusted comparison).ConclusionsDigital health coaching was successfully implemented for patients awaiting elective lower limb arthroplasty. We observed significant improvements in participants’ PAM scores after the programme, with the largest increase in participants with lower activation scores at Entry. Further study is needed to confirm the effects of digital health coaching in this and other perioperative groups.

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“…However, the lack of evidence-informed, systematically developed interventions raises questions about effectiveness, replicability, and, of critical importance, uptake and continued engagement by patients and healthcare professionals (HCPs). Uptake and engagement was the topic of an editorial [ 23 ] that highlighted the need to address several key questions in the context of intervention development. These include determining whether a digital solution is wanted by patients and HCPs and why; to what extent they believe it would be beneficial; how a digital intervention could be used to optimise outcomes; whether it would be cost-effective; and whether is there a risk of increasing inequalities in perioperative care.…”

Section: Introductionmentioning

confidence: 99%

Systematic development and feasibility testing of a multibehavioural digital prehabilitation intervention for patients approaching major surgery (iPREPWELL): A study protocol

et al. 2022

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Improving outcomes for people undergoing major surgery, specifically reducing perioperative morbidity and mortality remains a global health challenge. Prehabilitation involves the active preparation of patients prior to surgery, including support to tackle risk behaviours that mediate and undermine physical and mental health and wellbeing. The majority of prehabilitation interventions are delivered in person, however many patients express a preference for remotely-delivered interventions that provide them with tailored support and the flexibility. Digital prehabilitation interventions offer scalability and have the potential to benefit perioperative healthcare systems, however there is a lack of robustly developed and evaluated digital programmes for use in routine clinical care. We aim to systematically develop and test the feasibility of an evidence and theory-informed multibehavioural digital prehabilitation intervention ‘iPREPWELL’ designed to prepare patients for major surgery. The intervention will be developed with reference to the Behaviour Change Wheel, COM-B model, and the Theoretical Domains Framework. Codesign methodology will be used to develop a patient intervention and accompanying training intervention for healthcare professionals. Training will be designed to enable healthcare professionals to promote, support and facilitate delivery of the intervention as part of routine clinical care. Patients preparing for major surgery and healthcare professionals involved with their clinical care from two UK National Health Service centres will be recruited to stage 1 (systematic development) and stage 2 (feasibility testing of the intervention). Participants recruited at stage 1 will be asked to complete a COM-B questionnaire and to take part in a qualitative interview study and co-design workshops. Participants recruited at stage 2 (up to twenty healthcare professionals and forty participants) will be asked to take part in a single group intervention study where the primary outcomes will include feasibility, acceptability, and fidelity of intervention delivery, receipt, and enactment. Healthcare professionals will be trained to promote and support use of the intervention by patients, and the training intervention will be evaluated qualitatively and quantitatively. The multifaceted and systematically developed intervention will be the first of its kind and will provide a foundation for further refinement prior to formal efficacy testing.

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Prehabilitation and preparation for surgery: has the digital revolution arrived?

Cited by 10 publications

References 16 publications

Multimodal prehabilitation service for patients with colorectal cancer: the challenges of implementation

Multimodal prehabilitation service for patients with colorectal cancer: the challenges of implementation

Digital health coaching to improve patient preparedness for elective lower limb arthroplasty: a quality improvement project

Systematic development and feasibility testing of a multibehavioural digital prehabilitation intervention for patients approaching major surgery (iPREPWELL): A study protocol

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