Understanding Challenges in Prehabilitation for Patients with Multiple Chronic Conditions

Zhu, Haining; Moffa, Zachary J.; Wang, Xiying; Abdullah, Saeed; Julaiti, Juxihong; Carroll, John M.

doi:10.1145/3240925.3240959

Cited by 8 publications

(3 citation statements)

References 42 publications

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“…The dose of prehabilitation is also determined by the intensity of individual sessions which must be su ciently high to have an effect while being tolerable for the target population (101). Although there were few adverse events directly related to prehabilitation, some EEs reported that patients from the intervention group dropped out due to high-intensity (30)(31)(32).…”

Section: Discussionmentioning

confidence: 99%

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

Rombey,

Eckhardt,

Kiselev

et al. 2023

Preprint

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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 regardless of design, analysis type and completion status. 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. Among the completed EEs, there were 22 trial-based EEs, and three model-based EEs, 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. Overall, 16/25 (64.0%) EEs found prehabilitation cost-effective based on direction of effects. 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, and in one EE prehabilitation was not cost-effective. Discussion 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. Funding information and systematic review registration Funding: Innovationsausschuss of the Federal Joint Committee (G-BA) (01NVF18024). Registration: PROSPERO CRD42020182813.

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Section: Discussionmentioning

confidence: 99%

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

Rombey,

Eckhardt,

Kiselev

et al. 2023

Preprint

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“…The monitoring of exercise and activity in abdominal cancer patients is important, as adherence to prescribed prehabilitation programmes has been associated with improved aerobic fitness and the reduction of postoperative complications [3,4]. However, activity detection in this population has been limited to step counting.…”

Section: Introductionmentioning

confidence: 99%

Human Movement Monitoring and Analysis for Prehabilitation Process Management

Al-Naime

Al-Anbuky

Mawston

2020

JSAN

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Cancer patients assigned for abdominal surgery are often given exercise programmes (prehabilitation) prior to surgery, which aim to improve fitness in order to reduce pre-operative risk. However, only a small proportion of patients are able to partake in supervised hospital-based prehabilitation because of inaccessibility and a lack of resources, which often makes it difficult for health professionals to accurately monitor and provide feedback on exercise and activity levels. The development of a simple tool to detect the type and intensity of physical activity undertaken outside the hospital setting would be beneficial to both patients and clinicians. This paper aims to describe the key exercises of a prehabilitation programme and to determine whether the types and intensity of various prehabilitation exercises could be accurately identified using Fourier analysis of 3D accelerometer sensor data. A wearable sensor with an inbuilt 3D accelerometer was placed on both the ankle and wrist of five volunteer participants during nine prehabilitation exercises which were performed at low to high intensity. Here, the 3D accelerometer data are analysed using fast Fourier analysis, where the dominant frequency and amplitude components are extracted for each activity performed at low, moderate, and high intensity. The findings indicate that the 3D accelerometer located at the ankle is suitable for detecting activities such as cycling and rowing at low, moderate, and high exercise intensities. However, there is some overlap in the frequency and acceleration amplitude components for overland and treadmill walking at a moderate intensity.

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“…Studying prehabilitation thus offers a unique glimpse into patient work, which has remained until recently understudied; studies which explore patient work uncover insights regarding how clinical processes and spaces are not designed for patient collaboration [8]. We believe we can uncover similar insights regarding prehabilitation, especially considering that prehabilitation emphasises patient roles, has notably short durations, and requires complex patient-centered treatments [9]. Unfortunately, prehabilitation engagement is often low [4].…”

Section: Introductionmentioning

confidence: 99%

Healthcare Opportunities

Zhu

Carroll

2018

Companion of the 2018 ACM Conference on Computer Supported Cooperative Work and Social Computing

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Habilitation services, notably prehabilitation and rehabilitation, are important components of patients' surgical care. Contrary to traditional reactive healthcare models, proactive healthcare in the form of prehabilitation has shown promise in facilitating surgical patients' recoveries beyond rehabilitation alone. This paper examines prehabilitation from the perspective of seven healthcare professionals, and relies on their interviews to better understand prehabilitation and how technology can be integrated into its processes. Specifically, we offer descriptions for why patients participate in prehabilitation, how clinicians deliver prehabilitation, and how technology could be utilized during these processes.

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Understanding Challenges in Prehabilitation for Patients with Multiple Chronic Conditions

Cited by 8 publications

References 42 publications

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

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

Human Movement Monitoring and Analysis for Prehabilitation Process Management

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