Prehabilitation <i>versus</i> Rehabilitation

Gillis, Chelsia; Li, Chao; Lee, Lawrence; Awasthi, Rashami; Augustin, Berson; Gamsa, Ann; Liberman, Alexander; Stein, Barry; Charlebois, Patrick; Feldman, Liane S.; Carli, Francesco

doi:10.1097/aln.0000000000000393

Cited by 679 publications

(356 citation statements)

References 39 publications

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“…A prospective trial examining how patients who underwent a prehabilitation regimen prior to colorectal surgery did show that patients who had the largest gains in prehabilitation were more likely to return to their baseline functional scores but did not note any difference in complications [26]. Similarly patients undergoing prehabilitation had no difference in surgical outcomes compared to those undergoing post-operative rehabilitation [27,28]. A single study has shown that prehabilitation improves hospital lengths of stay without effecting complications for colorectal surgery patients [29].…”

Section: Discussionmentioning

confidence: 99%

Timed Stair Climbing Is the Single Strongest Predictor of Perioperative Complications in Patients Undergoing Abdominal Surgery

Reddy¹,

Singletary²,

Bradford³

et al. 2016

Journal of the American College of Surgeons

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Background Current methods to predict patients' peri-operative morbidity utilize complex algorithms with multiple clinical variables focusing primarily on organ-specific compromise. The aim of the present study is to determine the value of a timed stair climb (SC) in predicting peri-operative complications for patients undergoing abdominal surgery. Study Design From March 2014 to July 2015, 362 patients attempted SC while being timed prior to undergoing elective abdominal surgery. Vital signs were measured before and after SC. Ninety day post-operative complications were assessed by the Accordion Severity Grading System. The prognostic value of SC was compared to the ACS NSQIP risk calculator. Results A total of 264 (97.4%) patients were able to complete SC. SC time directly correlated to changes in both mean arterial pressure and heart rate as an indicator of stress. An Accordion grade 2 or higher complication occurred in 84 (25%) patients. There were 8 mortalities (2.4%). Patients with slower SC times had an increased complication rate (P<0.0001). In multivariable analysis SC time was the single strongest predictor of complications (OR=1.029, P<0.0001), and no other clinical co-morbidity reached statistical significance. Receiver operative characteristic curves predicting post-operative morbidity by SC time was superior to that of the ACS risk calculator (AUC 0.81 vs. 0.62, P<0.0001). Additionally slower patients had a greater deviation from predicted length of hospital stay (P=0.034) Conclusions SC provides measurable stress, accurately predicts post-operative complications, and is easy to administer in patients undergoing abdominal surgery. Larger patient populations with a diverse group of operations will be needed to further validate the use of SC in risk prediction models.

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Section: Discussionmentioning

confidence: 99%

Timed Stair Climbing Is the Single Strongest Predictor of Perioperative Complications in Patients Undergoing Abdominal Surgery

Reddy¹,

Singletary²,

Bradford³

et al. 2016

Journal of the American College of Surgeons

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“…However, enhanced benefits relating to urinary incontinence were found for prehabilitative PFMT [19]. Other studies not included in the review (because they did not meet one or more eligibility criteria) found improved outcomes for patients in the prehabilitation versus rehabilitation period, for example, combined interventions for patients with colorectal (exercise, nutrition and counselling) [30] or lung cancer (exercise and nutrition) [31]. Pre-operative exercise for lung cancer patients was associated with a number of benefits for patients [32].…”

Section: Discussionmentioning

confidence: 99%

An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

2017

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Purpose The purpose of the study is to systematically review and synthesise randomised controlled trials investigating the effectiveness of prehabilitation compared to usual care for newly diagnosed, adult-onset cancer patients. Methods MEDLINE, EMBASE, PsycINFO, CINAHL and SSCI were searched up to April 2017. Studies were included if disease-related, treatment-related, patient-reported and health service utilisation outcomes were assessed. Two reviewers independently reviewed and appraised the risk of bias of each study. Results Eighteen studies were included. Interventions comprised one or more of the following components: psychological support, education and exercise. Meta-analyses found that pelvic floor muscle training (PFMT) significantly increased odds of continence at 3 months (OR = 3.29, 95% CI = 1.57-6.91), but did not significantly reduce daily pad use at 6 months post-surgery Mean Difference (MD)= ( = − 0.96, 95% CI = − 2.04-0.12) for prostate cancer patients. Although quality of life improved due to PFMT, functional ability or distress did not. Further meta-analyses indicated that presurgical exercise significantly reduced length of hospital stay (MD = − 4.18, 95% CI = − 5.43-− 2.93) and significantly lowered odds of post-surgery complications (OR = 0.25, 95% CI = 0.10-0.66) for lung cancer patients. Psychology-based prehabilitation significantly improved mood, physical wellbeing and immune function for prostate cancer patients and improved fatigue and psychological outcomes and a trend for better quality of life among breast cancer patients. Risk of bias was high for most studies. Conclusions Prehabilitation appears to benefit cancer patients. Rigorous trials are needed to investigate the effectiveness of prehabilitation among other cancer sites and other related effects. The cost-effectiveness of prehabilitation remains unanswered. Implications for cancer survivors Providing interventions earlier in the care pathway may lead to better outcomes for patients during survivorship.

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“…Numerous studies in recent years have focused on physical “prehabilitation” to decrease post-operative complications and/or improve post-operative physical function (72–75), but to the best of our knowledge no study has evaluated whether physical and/or cognitive prehabilitation might decrease the risk of POCD. The plasticity of the human brain in response to both physical (76) and cognitive (77) exercise suggest that such interventions may help prevent and/or treat POCD.…”

Section: Who Is At Risk For Developing Pocd?mentioning

confidence: 99%

Postoperative Cognitive Dysfunction

Berger

Nadler

Browndyke

et al. 2015

Anesthesiology Clinics

223

119

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Ever since Bedford’s seminal Lancet case series in 1955, we have known that perioperative care is sometimes followed by significant cognitive dysfunction (1). Although the safety of perioperative care has improved dramatically since 1955, the descriptions of cognitive dysfunction in that case series are eerily similar to the complaints of current patients suffering from post-operative cognitive dysfunction (POCD). POCD remains a common post-operative complication associated with significant morbidity and even mortality, especially among elderly patients. There has been a great deal of interest in and controversy about POCD, from how it is measured, to how long it lasts, to its precise implications for patients. This interest and controversy is reflected partly in the increasing number of papers published on this subject recently (shown in Figure 1). Recent work has also suggested surgery may be associated with cognitive improvement in some patients (2–4), termed Post-Operative Cognitive Improvement (POCI). As the number of surgeries performed worldwide approaches 250 million per year (5) (with an increasing number elderly patients), optimizing postoperative cognitive function and preventing/treating POCD are major public health issues. In this article we review the literature on POCD and POCI, and discuss current research challenges in this area.

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Prehabilitation versus Rehabilitation

Abstract: Meaningful changes in postoperative functional exercise capacity can be achieved with a prehabilitation program.

Cited by 679 publications

References 39 publications

Timed Stair Climbing Is the Single Strongest Predictor of Perioperative Complications in Patients Undergoing Abdominal Surgery

Timed Stair Climbing Is the Single Strongest Predictor of Perioperative Complications in Patients Undergoing Abdominal Surgery

An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

Postoperative Cognitive Dysfunction

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