Prehabilitation for Vascular Surgery Patients: Challenges and Opportunities

Shovel, Louisa; Morkane, Clare

doi:10.1016/j.cjca.2022.02.017

Cited by 9 publications

(7 citation statements)

References 55 publications

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“… n.a. Not defined Not defined Not defined Not defined Shovel & Morkane [ 56 ] Review article n.a. n.a.…”

Section: Resultsmentioning

confidence: 99%

“…The possibility to complete the intervention at home is helpful for frail patients because of their limited mobility: transportation is a significant barrier for participation. Dependency on others to be transported to participate in sessions makes patients feel like a burden and prevents regular attendance or any participation [ 31 , 42 , 45 , 48 , 49 , 52 , 54 , 56 , 59 ]. Despite less supervision, support by a health care professional and equipment being available in the patients’ homes, home programmes can significantly increase accessibility and is often preferred by patients [ 31 , 37 , 41 , 43 , 58 ].…”

Section: Resultsmentioning

confidence: 99%

“…Despite less supervision, support by a health care professional and equipment being available in the patients’ homes, home programmes can significantly increase accessibility and is often preferred by patients [ 31 , 37 , 41 , 43 , 58 ]. Video-conferencing and digital tools like wearable fitness trackers or health apps are helpful in remote monitoring of the patients [ 38 , 43 , 56 ].…”

Section: Resultsmentioning

confidence: 99%

“…Physician support is needed to reduce patients’ uncertainty about the importance of the intervention. Professionals should monitor the patient’s activities, set goals and rewards together with the patients to make them feel directed within the prehabilitation programme [ 36 , 44 , 48 , 53 , 56 , 59 , 61 ].…”

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%

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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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