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Smyth E, Brennan L, Enright R, Sekhon M, Dickson J, Hussey J, Guinan E. The acceptability of exercise prehabilitation before cancer surgery among patients, family members and health professionals: a mixed methods evaluation. Support Care Cancer 2024; 32:399. [PMID: 38819477 PMCID: PMC11142941 DOI: 10.1007/s00520-024-08574-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/13/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Exercise prehabilitation aims to increase preoperative fitness, reduce post-operative complications, and improve health-related quality of life. For prehabilitation to work, access to an effective programme which is acceptable to stakeholders is vital. The aim was to explore acceptability of exercise prehabilitation before cancer surgery among key stakeholders specifically patients, family members and healthcare providers. METHODS A mixed-methods approach (questionnaire and semi-structured interview) underpinned by the Theoretical Framework of Acceptability was utilised. Composite acceptability score, (summation of acceptability constructs and a single-item overall acceptability construct), and median of each construct was calculated. Correlation analysis between the single-item overall acceptability and each construct was completed. Qualitative data was analysed using deductive and inductive thematic analysis. RESULTS 244 participants completed the questionnaire and n=31 completed interviews. Composite acceptability was comparable between groups (p=0.466). Four constructs positively correlated with overall acceptability: affective attitude (r=0.453), self-efficacy (r=0.399), ethicality (r=0.298) and intervention coherence (r=0.281). Qualitative data confirmed positive feelings, citing psychological benefits including a sense of control. Participants felt flexible prehabilitation program would be suitable for everyone, identifying barriers and facilitators to reduce burden. CONCLUSION Exercise prehabilitation is highly acceptable to key stakeholders. Despite some burden, it is a worthwhile and effective intervention. Stakeholders understand its purpose, are confident in patients' ability to participate, and regard it is an important intervention contributing to patients' psychological and physical wellbeing. IMPLICATIONS •Introduction should be comprehensively designed and clearly presented, providing appropriate information and opportunity for questions. •Programmes should be patient-centred, designed to overcome barriers and address patients' specific needs and goals. •Service must be appropriately resourced with a clear referral-pathway.
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Affiliation(s)
- Emily Smyth
- Department of Physiotherapy, Trinity College Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Louise Brennan
- Department of Physiotherapy, Trinity College Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Rachel Enright
- Department of Physiotherapy, Trinity College Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Mandeep Sekhon
- St George's, University of London, Population Health Research Institute, London, United Kingdom
| | | | - Juliette Hussey
- Department of Physiotherapy, Trinity College Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emer Guinan
- Trinity St James's Cancer Institute, Dublin, Ireland.
- The Beacon Hospital, Dublin, Ireland.
- Department of Surgery, Trinity College Dublin, Dublin, Ireland.
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Vu J, Koh C, Solomon M, Brown K, Karunaratne S, Cole R, Smith P, Raichurkar P, Denehy L, Riedel B, Steffens D. Patients' and carers' views on research priorities in prehabilitation for cancer surgery. Support Care Cancer 2024; 32:378. [PMID: 38787478 PMCID: PMC11126464 DOI: 10.1007/s00520-024-08585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION The views of patients and carers are important for the development of research priorities. This study aimed to determine and compare the top research priorities of cancer patients and carers with those of multidisciplinary clinicians with expertise in prehabilitation. MATERIALS AND METHODS This cross-sectional study surveyed patients recovering from cancer surgery at a major tertiary hospital in Sydney, Australia, and/or their carers between March and July 2023. Consenting patients and carers were provided a list of research priorities according to clinicians with expertise in prehabilitation, as determined in a recent International Delphi study. Participants were asked to rate the importance of each research priority using a 5-item Likert scale (ranging from 1 = very high research priority to 5 = very low research priority). RESULTS A total of 101 patients and 50 carers participated in this study. Four areas were identified as research priorities, achieving consensus of highest importance (> 70% rated as "high" or "very high" priority) by patients, carers, and clinical experts. These were "optimal composition of prehabilitation programs" (77% vs. 82% vs. 88%), "effect of prehabilitation on surgical outcomes" (85% vs. 90% vs. 95%), "effect of prehabilitation on functional outcomes" (83% vs. 86% vs. 79%), and "effect of prehabilitation on patient reported outcomes" (78% vs. 84% vs. 79%). Priorities that did not reach consensus of high importance by patients despite reaching consensus of highest importance by experts included "identifying populations most likely to benefit from prehabilitation" (70% vs. 76% vs. 90%) and "defining prehabilitation core outcome measures" (66% vs. 74% vs. 87%). "Prehabilitation during neoadjuvant therapies" reached consensus of high importance by patients but not by experts or carers (81% vs. 68% vs. 69%). CONCLUSION This study delineated the primary prehabilitation research priorities as determined by patients and carers, against those previously identified by clinicians with expertise in prehabilitation. It is recommended that subsequent high-quality research and resource allocation be directed towards these highlighted areas of importance.
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Affiliation(s)
- Jennifer Vu
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, Australia
| | - Kilian Brown
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
| | - Ruby Cole
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
| | - Phillippa Smith
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, Australia
| | - Pratik Raichurkar
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
| | - Linda Denehy
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Bernhard Riedel
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia.
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia.
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, Australia.
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Li Q, Guo C, Cao B, Zhou F, Wang J, Ren H, Li Y, Wang M, Liu Y, Zhang H, Ma L. Safety and efficacy evaluation of personalized exercise prescription during chemotherapy for lung cancer patients. Thorac Cancer 2024; 15:906-918. [PMID: 38462754 PMCID: PMC11016390 DOI: 10.1111/1759-7714.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND To explore the safety and effectiveness of personalized exercise intervention during chemotherapy for lung cancer patients who were relatively weak and with compromised cardiopulmonary function. METHODS Thirty-eight lung cancer patients treated with chemotherapy at Peking University Third Hospital were enrolled in this prospective study. The exercise group (N = 21) received individualized exercise guidance based on personal test results and exercised regularly, while the control group (N = 17) only received exercise education and planed exercise methods according to their own preferences. Both groups underwent three fitness tests and clinical indicator assessments at 0, 6, and 12 weeks after starting the exercise, and the differences in trends of various indicators between the two groups were compared. RESULTS No exercise-related adverse events occurred during the 12-week exercise period. After 12 weeks of exercise training, in terms of fitness, the exercise group showed significant improvements in 6-min walk test (6MWT) (p < 0.001), peak oxygen consumption (VO2peak) (p = 0.005), muscle content (p < 0.001), muscle percentage (p < 0.001), and grip strength (p = 0.008) compared to the control group. In terms of clinical indicators, the exercise group showed significant improvements in vital capacity (p = 0.018), D-dimer (p = 0.031), and C-reactive protein (CRP) (p = 0.01), uric acid (p = 0.003), triglycerides (p < 0.001), functional average score (p < 0.001), and main symptom average score (p = 0.004) compared to the control group in trends over time. CONCLUSION Rehabilitation exercises using individualized exercise prescriptions tailored by exercise prescription specialists during chemotherapy are safe for lung cancer patients. Adhering to exercise can achieve comprehensive improvements in physical fitness and quality of life at 12 weeks.
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Affiliation(s)
- Qian Li
- Department of Medical Oncology and Radiation SicknessPeking University Third HospitalBeijingChina
| | - Chen Guo
- School of Sport ScienceBeijing Sport UniversityBeijingChina
| | - Baoshan Cao
- Department of Medical Oncology and Radiation SicknessPeking University Third HospitalBeijingChina
| | - Fanjie Zhou
- School of Sport ScienceBeijing Sport UniversityBeijingChina
| | - Jiulong Wang
- China Institute of Sports and Health ScienceBeijing Sport UniversityBeijingChina
| | - Hong Ren
- School of Sport ScienceBeijing Sport UniversityBeijingChina
| | - Yanchun Li
- China Institute of Sports and Health ScienceBeijing Sport UniversityBeijingChina
| | - Mopei Wang
- Department of Medical Oncology and Radiation SicknessPeking University Third HospitalBeijingChina
| | - Yane Liu
- Department of Medical Oncology and Radiation SicknessPeking University Third HospitalBeijingChina
| | - Hua Zhang
- Research Center of Clinical EpidemiologyPeking University Third HospitalBeijingChina
| | - Liwen Ma
- Department of Medical Oncology and Radiation SicknessPeking University Third HospitalBeijingChina
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Kerstiens S, Gleason LJ, Huisingh-Scheetz M, Landi AJ, Rubin D, Ferguson MK, Quinn MT, Holl JL, Madariaga MLL. Barriers and facilitators to smartwatch-based prehabilitation participation among frail surgery patients: a qualitative study. BMC Geriatr 2024; 24:129. [PMID: 38308234 PMCID: PMC10835899 DOI: 10.1186/s12877-024-04743-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/24/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND For older, frail adults, exercise before surgery through prehabilitation (prehab) may hasten return recovery and reduce postoperative complications. We developed a smartwatch-based prehab program (BeFitMe) for older adults that encourages and tracks at-home exercise. The objective of this study was to assess patient perceptions about facilitators and barriers to prehab generally and to using a smartwatch prehab program among older adult thoracic surgery patients to optimize future program implementation. METHODS We recruited patients, aged ≥50 years who had or were having surgery and were screened for frailty (Fried's Frailty Phenotype) at a thoracic surgery clinic at a single academic institution. Semi-structured interviews were conducted by telephone after obtaining informed consent. Participants were given a description of the BeFitMe program. The interview questions were informed by The Five "Rights" of Clinical Decision-Making framework (Information, Person, Time, Channel, and Format) and sought to identify the factors perceived to influence smartwatch prehab program participation. Interview transcripts were transcribed and independently coded to identify themes in for each of the Five "Rights" domains. RESULTS A total of 29 interviews were conducted. Participants were 52% men (n = 15), 48% Black (n = 14), and 59% pre-frail (n = 11) or frail (n = 6) with a mean age of 68 ± 9 years. Eleven total themes emerged. Facilitator themes included the importance of providers (right person) clearly explaining the significance of prehab (right information) during the preoperative visit (right time); providing written instructions and exercise prescriptions; and providing a preprogrammed and set-up (right format) Apple Watch (right channel). Barrier themes included pre-existing conditions and disinterest in exercise and/or technology. Participants provided suggestions to overcome the technology barrier, which included individualized training and support on usage and responsibilities. CONCLUSIONS This study reports the perceived facilitators and barriers to a smartwatch-based prehab program for pre-frail and frail thoracic surgery patients. The future BeFitMe implementation protocol must ensure surgical providers emphasize the beneficial impact of participating in prehab before surgery and provide a written prehab prescription; must include a thorough guide on smartwatch use along with the preprogrammed device to be successful. The findings are relevant to other smartwatch-based interventions for older adults.
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Affiliation(s)
- Savanna Kerstiens
- Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, IL, USA.
| | - Lauren J Gleason
- Department of Medicine, Section of Geriatrics & Palliative Medicine, Biological Sciences Division, University of Chicago Medicine, Chicago, IL, USA
| | - Megan Huisingh-Scheetz
- Department of Medicine, Section of Geriatrics & Palliative Medicine, Biological Sciences Division, University of Chicago Medicine, Chicago, IL, USA
| | - A Justine Landi
- Department of Medicine, Section of Geriatrics & Palliative Medicine, Biological Sciences Division, University of Chicago Medicine, Chicago, IL, USA
| | - Daniel Rubin
- Department of Anesthesia and Critical Care, Biological Sciences Division, University of Chicago Medicine, Chicago, IL, USA
| | - Mark K Ferguson
- Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Michael T Quinn
- Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Jane L Holl
- Department of Neurology, Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Maria Lucia L Madariaga
- Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, IL, USA
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Machado P, Pimenta S, Garcia AL, Nogueira T, Silva S, Dos Santos CL, Martins MV, Canha A, Oliveiros B, Martins RA, Cruz J. Effect of Preoperative Home-Based Exercise Training on Quality of Life After Lung Cancer Surgery: A Multicenter Randomized Controlled Trial. Ann Surg Oncol 2024; 31:847-859. [PMID: 37934383 PMCID: PMC10761542 DOI: 10.1245/s10434-023-14503-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Preoperative exercise training is recommended for improvement of clinical outcomes after lung cancer (LC) surgery. However, its effectiveness in preventing postoperative decline in quality of life (QoL) remains unknown. This study investigated the effect of preoperative home-based exercise training (PHET) on QoL after LC surgery. METHODS Patients awaiting LC resection were randomized to PHET or a control group (CG). The PHET program combined aerobic and resistance exercise, with weekly telephone supervision. Primary outcome was QoL-assessed with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQ-C30) at baseline, before surgery, and 1 month after surgery. The secondary outcomes were hospital length of stay and physical performance. The main analysis included a factorial repeated-measures analysis of variance. Additionally, the proportion of patients experiencing clinical deterioration from baseline to post-surgery was assessed. RESULTS The study included 41 patients (68.1 ± 9.3 years; 68.3% male) in the intention-to-treat analysis (20 PHET patients, 21 CG patients). A significant group × time interaction was observed for global QoL (p = 0.004). Between-group differences in global QoL were statistically and clinically significant before surgery (mean difference [MD], 13.5 points; 95% confidence interval [CI], 2.4-24.6; p = 0.019) and after surgery (MD, 12.4 points; 95% CI, 1.3-23.4; p = 0.029), favoring PHET. Clinical deterioration of global QoL was reported by 71.4% of the CG patients compared with 30 % of the PHET patients (p = 0.003). Between-group differences in favor of PHET were found in pain and appetite loss as well as in physical, emotional and role functions after surgery (p < 0.05). Compared with CG, PHET was superior in improving preoperative five-times sit-to-stand and postoperative exercise capacity (p < 0.05). No between-group differences in other secondary outcomes were observed. CONCLUSION The study showed that PHET can effectively prevent the decline in QoL after LC surgery.
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Affiliation(s)
- Pedro Machado
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences of the Polytechnic of Leiria (ESSLei), Leiria, Portugal.
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, Coimbra, Portugal.
- Physioclem, Physical Therapy Clinics, Alcobaça, Portugal.
| | - Sara Pimenta
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences of the Polytechnic of Leiria (ESSLei), Leiria, Portugal
| | - Ana Luís Garcia
- Thoracic Surgery Unit, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Tiago Nogueira
- Thoracic Surgery Unit, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Sónia Silva
- Pulmonology Department, Leiria Hospital Center, Leiria, Portugal
| | | | - Maria Vitória Martins
- Pulmonology Department, District Hospital of Figueira da Foz, Figueira da Foz, Portugal
| | - André Canha
- Physical Medicine and Rehabilitation Department, District Hospital of Santarém, Santarém, Portugal
| | - Bárbara Oliveiros
- Laboratory of Biostatistics and Medical Informatics (LBIM), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal
- Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
| | - Raul A Martins
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, Coimbra, Portugal
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences of the Polytechnic of Leiria (ESSLei), Leiria, Portugal
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Machado PFA, Oliveiros B, Martins RA, Cruz J. ASO Author Reflections: Impact of a Preoperative Home-Based Exercise Program on Quality of Life After Lung Cancer Resection. Ann Surg Oncol 2024; 31:897-898. [PMID: 37980706 DOI: 10.1245/s10434-023-14620-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Pedro Filipe André Machado
- School of Health Sciences of the Polytechnic of Leiria (ESSLei), Center for Innovative Care and Health Technology (ciTechCare), Leiria, Portugal.
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, Coimbra, Portugal.
- Physical Therapy Clinics, Alcobaça, Portugal.
| | - Bárbara Oliveiros
- Laboratory of Biostatistics and Medical Informatics (LBIM), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
| | - Raul A Martins
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, Coimbra, Portugal
| | - Joana Cruz
- School of Health Sciences of the Polytechnic of Leiria (ESSLei), Center for Innovative Care and Health Technology (ciTechCare), Leiria, Portugal
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Crowe J, Edbrooke L, Khot A, Denehy L, Francis JJ. Enablers and barriers to referral and delivery of multidisciplinary prehabilitation in the autologous stem cell transplant population: a theory-based interview study. Support Care Cancer 2023; 32:25. [PMID: 38095731 DOI: 10.1007/s00520-023-08234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/03/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE Health care professionals (HCP) play a vital role in effectiveness of prehabilitation programs, but information is limited about what assists HCP deliver an effective service. This study evaluated HCP perceptions of enablers and barriers to two behaviours: referral for, and delivery of, multidisciplinary prehabilitation prior to autologous stem cell transplant. METHODS Based on the Theoretical Domains Framework (TDF) of behaviour change, we conducted semi-structured interviews, purposively sampling 14 participants (from various healthcare disciplines) at a tertiary cancer centre. Discipline-specific topic guides were created based on the TDF and the behaviours appropriate to each discipline. Interviews were audio-recorded, transcribed verbatim, anonymised, content analysed (grouping, then labelling, thematically similar responses), and classified into theoretical domains. Structured decision rules were used to classify themes as high, medium, or low priority. RESULTS Fifty enablers and 31 barriers were identified; of these 26 enablers and 16 barriers classified as high priority. Four domains had the most frequent high-priority enablers: Social professional role and identity (e.g. multidisciplinary teamwork); Beliefs about consequences (e.g. patient benefit); Memory, attention, and decision processes (e.g. refer as early as possible); and Environmental context and resources (e.g. electronic medical records are beneficial). High-priority barriers were most frequent in four domains: Memory, attention, and decision processes (e.g. conflicting views about who should be referred); Environmental context and resources (e.g. lack of time); Social influences (e.g. families); and Emotions (e.g. patient distress). CONCLUSION Participants reported more enablers than barriers. Findings can support delivery of prehabilitation programs in hospital settings where uptake remains low.
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Affiliation(s)
- Jessica Crowe
- Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia.
| | - Lara Edbrooke
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Amit Khot
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jill J Francis
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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Jandu AK, Nitayamekin A, Stevenson J, Beed M, Vohra RS, Wilson VG, Lobo DN. Post-Cancer Treatment Reflections by Patients Concerning the Provisions and Support Required for a Prehabilitation Programme. World J Surg 2023; 47:2724-2732. [PMID: 37698631 PMCID: PMC10545643 DOI: 10.1007/s00268-023-07170-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Evidence suggests that physical fitness interventions, mental health support and nutritional advice before surgery (prehabilitation) could reduce hospital stay and improve quality of life of patients with cancer. In this study we captured the opinions of a group of patients with cancer undergoing these interventions after treatment to discover what a prehabilitation programme should encompass. METHODS Patients from the Cancer and Rehabilitation Exercise (CARE) programme based in Nottingham took part in a 26-point online questionnaire about the design of prehabilitation programmes. RESULTS The questionnaire was completed over a 2-week period in December 2021 by 54 patients from the CARE programme. Their responses were as follows: 44 (81.5%) participants would have participated in prehabilitation had it been available to them and 28 (51.9%) ranked physical exercise as the most important component. Forty (74.1%) participants believed the counselling aspect of prehabilitation would have contributed to a successful outcome and 35 (64.8%) thought dietary advice would have benefitted them before surgery. Thirty-one (57.4%) participants preferred the programme to take place in a fitness centre, rather than at home or hospital and 43 (79.6%) would have liked to have known about prehabilitation from their doctor at the time of diagnosis. CONCLUSIONS Patients are interested in prehabilitation to become more physically fit and mentally prepared for surgery. They expressed the need for a focus on physical exercise, counselling to improve mental health and personalised nutritional advice. Tailoring a prehabilitation programme, with input from patients, could contribute to improving patient outcomes following cancer treatments.
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Affiliation(s)
- Amrita Kaur Jandu
- School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Arpanun Nitayamekin
- School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Josh Stevenson
- The Notts County Foundation CARE Programme, Portland Leisure Centre, Nottingham, UK
| | - Martin Beed
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
| | - Ravinder S Vohra
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
| | - Vincent G Wilson
- School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
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Piché A, Santa Mina D, Lambert S, Doré I. Assessing real-world implementability of a multimodal group-based tele-prehabilitation program in cancer care: a pragmatic feasibility study. Front Oncol 2023; 13:1271812. [PMID: 37965450 PMCID: PMC10641394 DOI: 10.3389/fonc.2023.1271812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/04/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction Multimodal prehabilitation is intended to optimize a patient's mental and physical health prior to surgery. Most multimodal prehabilitation interventions are delivered on a one-on-one format, which may limit benefits associated with social interactions that can be achieved in a group context, and are delivered in-person, which may limit the accessibility. The purpose of this study was to develop a group-based, multimodal, tele-prehabilitation intervention for individuals diagnosed with cancer (iACTIF) and assess its implementability in a "real-world" clinical setting by measuring feasibility, acceptability, fidelity, and preliminary effects. Methods A prospective, single-group, pragmatic feasibility study was conducted with assessments at baseline, pre-surgery, and 12-weeks post-surgery. iACTIF consisted of three 90-min live videoconference sessions per week, including exercise and educational components. Descriptive statistics were used to document feasibility, acceptability, and fidelity indicators. Paired t-test, Wilcoxon test, and Cohen's D-test were conducted to assess changes in health-related outcomes. Results A total of 25 participants (mean age ± SD= 60.2 ± 14.0) were recruited. The feasibility assessment revealed a low referral rate (31.4%) and a high study retention (98%) and program attendance [session attended/possible session] (70.2%), with a prehabilitation window of 32.7 days (SD= 20.9, median= 28). Acceptability was high (84%-100%) according to satisfaction, utility and safety, delivery modality, and intention to continue physical activity and to recommend iACTIF to a relative. Pre-post-intervention assessments suggest positive changes on physical functional capacity based on the 2-min step test (mean difference= +18.9 steps, p=0.005), the 30-s sit-to-stand (mean difference= +1.1 repetition, p=0.011), and volume of moderate intensity physical activity per week (mean difference= +104.8 min, p<0.001). Fidelity was supported by conformity and coherence, with only minimal adjustments required to meet participants' needs. Discussion iACTIF implementability in a "real-world" clinical setting is promising, and preliminary outcomes suggest moderate benefits on physical health and small increase in mental health indicators.
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Affiliation(s)
- Alexia Piché
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, QC, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Sylvie Lambert
- St. Mary’s Research Centre, Montréal, QC, Canada
- Ingram School of Nursing, McGill University, Montréal, QC, Canada
| | - Isabelle Doré
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, QC, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
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van der Velde M, van der Leeden M, Geleijn E, Veenhof C, Valkenet K. What moves patients to participate in prehabilitation before major surgery? A mixed methods systematic review. Int J Behav Nutr Phys Act 2023; 20:75. [PMID: 37344902 DOI: 10.1186/s12966-023-01474-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Prehabilitation offers patients the opportunity to actively participate in their perioperative care by preparing themselves for their upcoming surgery. Experiencing barriers may lead to non-participation, which can result in a reduced functional capacity, delayed post-operative recovery and higher healthcare costs. Insight in the barriers and facilitators to participation in prehabilitation can inform further development and implementation of prehabilitation. The aim of this review was to identify patient-experienced barriers and facilitators for participation in prehabilitation. METHODS For this mixed methods systematic review, articles were searched in PubMed, EMBASE and CINAHL. Articles were eligible for inclusion if they contained data on patient-reported barriers and facilitators to participation in prehabilitation in adults undergoing major surgery. Following database search, and title and abstract screening, full text articles were screened for eligibility and quality was assessed using the Mixed Method Appraisal Tool. Relevant data from the included studies were extracted, coded and categorized into themes, using an inductive approach. Based on these themes, the Capability, Opportunity, Motivation, Behaviour (COM-B) model was chosen to classify the identified themes. RESULTS Three quantitative, 14 qualitative and 6 mixed methods studies, published between 2007 and 2022, were included in this review. A multitude of factors were identified across the different COM-B components. Barriers included lack of knowledge of the benefits of prehabilitation and not prioritizing prehabilitation over other commitments (psychological capability), physical symptoms and comorbidities (physical capability), lack of time and limited financial capacity (physical opportunity), lack of social support (social opportunity), anxiety and stress (automatic motivation) and previous experiences and feeling too fit for prehabilitation (reflective motivation). Facilitators included knowledge of the benefits of prehabilitation (psychological capability), having access to resources (physical opportunity), social support and encouragement by a health care professional (social support), feeling a sense of control (automatic motivation) and beliefs in own abilities (reflective motivation). CONCLUSIONS A large number of barriers and facilitators, influencing participation in prehabilitation, were found across all six COM-B components. To reach all patients and to tailor prehabilitation to the patient's needs and preferences, it is important to take into account patients' capability, opportunity and motivation. TRIAL REGISTRATION Registered in PROSPERO (CRD42021250273) on May 18th, 2021.
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Affiliation(s)
- Miriam van der Velde
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, NL, Netherlands.
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, NL, Netherlands.
| | - Marike van der Leeden
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, NL, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, NL, Netherlands
| | - Edwin Geleijn
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, NL, Netherlands
| | - Cindy Veenhof
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, NL, Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, NL, Netherlands
| | - Karin Valkenet
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, NL, Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, NL, Netherlands
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Machado P, Pimenta S, Garcia AL, Nogueira T, Silva S, Oliveiros B, Martins RA, Cruz J. Home-Based Preoperative Exercise Training for Lung Cancer Patients Undergoing Surgery: A Feasibility Trial. J Clin Med 2023; 12:jcm12082971. [PMID: 37109307 PMCID: PMC10146369 DOI: 10.3390/jcm12082971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/16/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Clinical guidelines recommend prehabilitation with exercise training to optimize recovery after lung cancer surgery. However, the lack of access to facility-based exercise programs is a major barrier to routine participation. This study aimed to assess the feasibility of a home-based exercise intervention before lung cancer resection. METHODS We conducted a prospective, two-site feasibility study, including patients scheduled for lung cancer surgery. Exercise prescription involved aerobic and resistance training with telephone-based supervision. The primary endpoint was overall feasibility (recruitment rate, retention rate, intervention adherence and acceptability). Secondary endpoints included safety and effects on health-related quality of life (HRQOL) and physical performance, evaluated at baseline, after the exercise intervention and 4-5 weeks after surgery. RESULTS Over three months, 15 patients were eligible, and all agreed to participate (recruitment rate: 100%). A total of 14 patients completed the exercise intervention, and 12 patients were evaluated postoperatively (retention rate: 80%). The median length of the exercise intervention was 3 weeks. Patients performed an aerobic and resistance training volume higher than prescribed (median adherence rates of 104% and 111%, respectively). A total of nine adverse events occurred during the intervention (Grade 1, n = 8; Grade 2, n = 1), the most common being shoulder pain. After the exercise intervention, significant improvements were observed in the HRQOL summary score (mean difference, 2.9; 95% confidence interval [CI], from 0.9 to 4.8; p = 0.049) and the five-times sit-to-stand test score (median difference, -1.5; 95% CI, from -2.1 to -0.9; p = 0.001). After surgery, no significant effects on HRQOL and physical performance were observed. CONCLUSION A short-term preoperative home-based exercise intervention is feasible before lung cancer resection and may enhance accessibility to prehabilitation. Clinical effectiveness should be investigated in future studies.
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Affiliation(s)
- Pedro Machado
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences of the Polytechnic of Leiria (ESSLei), 2411-901 Leiria, Portugal
- Univ Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, 3040-248 Coimbra, Portugal
- Physioclem, Physical Therapy Clinics, 2460-042 Alcobaça, Portugal
| | - Sara Pimenta
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences of the Polytechnic of Leiria (ESSLei), 2411-901 Leiria, Portugal
| | - Ana Luís Garcia
- Thoracic Surgery Unit, Portuguese Oncology Institute of Coimbra, 3000-075 Coimbra, Portugal
| | - Tiago Nogueira
- Thoracic Surgery Unit, Portuguese Oncology Institute of Coimbra, 3000-075 Coimbra, Portugal
| | - Sónia Silva
- Pulmonology Department, Leiria Hospital Center, 2410-197 Leiria, Portugal
| | - Bárbara Oliveiros
- Laboratory of Biostatistics and Medical Informatics (LBIM), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, 3000-548 Coimbra, Portugal
| | - Raul A Martins
- Univ Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, 3040-248 Coimbra, Portugal
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences of the Polytechnic of Leiria (ESSLei), 2411-901 Leiria, Portugal
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Patient characteristics and preferences for a surgical prehabilitation program design: results from a pilot survey. J Cancer Res Clin Oncol 2023; 149:1361-1367. [PMID: 36283998 DOI: 10.1007/s00432-022-04420-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/13/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Surgical prehabilitation aims to reduce a decline in the functional capacity thereby optimising health and fitness before surgery. One of the major barriers in successfully implementing a prehabilitation program in hospitals has been poor patient adherence. In our pilot survey on surgical patients, we sought to explore patient preferences regarding the program design, the barriers and enablers to patient participation in a multimodal prehabilitation program. METHODS The survey was administered to patients undergoing major abdominal surgery in the preoperative period. The first two parts of the instrument mainly included questions on demographics, social history, activity levels, interest towards prehabilitation program and their involvement in co-design, preferences towards the components of the program, the barriers and enablers. The last part of survey included symptom and physical assessments. RESULTS The survey was completed by 24 patients undergoing major abdominal surgery. The median age of our cohort was 71 (range 35-91) years and 75% were retired. 75% of our participants were extremely interested in improving health and fitness and 63% were very keen to co-design their program when explained. Home-based programs were preferred by most participants and among exercises, walking was preferred by 71% of the participants. One third of the participants were interested in professional dietary counselling. There were only two participants who preferred group psychological therapy while 25% preferred individual psychological counselling sessions. CONCLUSION Our survey highlighted a need to design a personalised program with tailored interventions due to the wide variation in the interest and preferences among surgical patients.
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Wong SSY, Cheung HHTI, Ng FF, Yau DKW, Wong MKH, Lau VNM, Leung WW, Mak TWC, Lee A. Effect of a patient education video and prehabilitation on the quality of preoperative person-centred coordinated care experience: protocol for a randomised controlled trial. BMJ Open 2022; 12:e063583. [PMID: 36175104 PMCID: PMC9528577 DOI: 10.1136/bmjopen-2022-063583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Multimodal prehabilitation, an emerging field within the Perioperative Medicine specialty, requires close multidisciplinary team coordination. The goal is to optimise the patient's health status in the 4-8 weeks before elective surgery to withstand surgical stress. Most patients are unfamiliar with the concept of prehabilitation but are interested in participating in such a programme after explanation. The objective of this randomised controlled trial is to evaluate the effect of prehabilitation (patient education video and multimodal prehabilitation) on the preoperative patient-centred coordinated care experience. METHOD AND ANALYSIS One hundred patients undergoing major elective surgery (cardiac, colorectal, hepatobiliary-pancreatic and urology) will be recruited into a two-group, parallel, superiority, single-blinded randomised controlled trial. Patients will be randomised to receive either preoperative patient education comprising of a video and prehabilitation programme with standard care (intervention) or standard care (control). The primary outcome measure will be the quality of preoperative patient care experience using the 11-item Chinese version of the Person-Centred Coordinated Care Experience Questionnaire (P3CEQ) before surgery. Secondary outcomes will include the change in Hospital Anxiety and Depression Scale (HADS) score from trial enrolment to before surgery, Quality of Recovery Score (QoR-15) on third day after surgery and Days Alive and At Home within 30 days after surgery (DAH30). Intention-to-treat and per-protocol analyses will be performed. ETHICS AND DISSEMINATION The Joint CUHK-NTEC Clinical Research Ethics Committee approved the study protocol (CREC Ref. No. 2021.518-T). The findings will be presented at scientific meetings, in peer-reviewed journals and to study participants. TRIAL REGISTRATION NUMBER ChiCTR2100053637.
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Affiliation(s)
- Sami Sum Yu Wong
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Helen Hoi TIng Cheung
- Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Floria Fung Ng
- Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Derek King Wai Yau
- Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Man Kin Henry Wong
- Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong, China
| | - Vivian Nga Man Lau
- Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong, China
| | - Wing Wa Leung
- Division of Colorectal Surgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Tony Wing Chung Mak
- Division of Colorectal Surgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Anna Lee
- Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
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14
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Waterland JL, Ismail H, Granger CL, Patrick C, Denehy L, Riedel B. Prehabilitation in high-risk patients scheduled for major abdominal cancer surgery: a feasibility study. Perioper Med (Lond) 2022; 11:32. [PMID: 35996196 PMCID: PMC9396890 DOI: 10.1186/s13741-022-00263-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background Patients presenting for major surgery with low cardiorespiratory fitness (deconditioning) and other modifiable risk factors are at increased risk of postoperative complications. This study investigated the feasibility of delivering prehabilitation in high-risk patients scheduled for major abdominal cancer surgery. Methods Eligible patients in this single-center cohort study included patients with poor fitness (objectively assessed by cardiopulmonary exercise testing, CPET) scheduled for elective major abdominal cancer surgery. Patients were recruited to participate in a prehabilitation program that spanned up to 6 weeks pre-operatively and comprised aerobic and resistance exercise training, breathing exercise, and nutritional support. The primary outcome assessed pre-specified feasibility targets: recruitment >70%, retention >85%, and intervention adherence >70%. Secondary outcomes were assessed for improved pre-operative functional status and health-related quality of life and for postoperative complications. Results Eighty-two (34%) out of 238 patients screened between April 2018 and December 2019 were eligible for recruitment. Fifty (61%) patients (52% males) with a median age of 71 (IQR, 63–77) years participated in the study. Baseline oxygen consumption the at anaerobic threshold and at peak exercise (mean±SD: 9.8±1.8 and 14.0±2.9 mL/kg/min, respectively) confirmed the deconditioned state of the study cohort. The retention rate within the prehabilitation program was 84%, with 42 participants returning for repeat CPET testing. While >60% of participants preferred to do home-based prehabilitation, adherence to the intervention was low—with only 12 (28%) and 15 (35%) of patients having self-reported compliance >70% with their exercise prescriptions. Conclusion Our prehabilitation program in high-risk cancer surgery patients did not achieve pre-specified targets for recruitment, retention, and self-reported program adherence. These findings underpin the importance of implementation research and strategies for the prehabilitation programs in major surgery. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12620000073909) retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s13741-022-00263-2.
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Affiliation(s)
- Jamie L Waterland
- Peter MacCallum Cancer Centre, Department of Anaesthesia, Perioperative and Pain Medicine, Melbourne, Australia. .,Department of Physiotherapy, The University of Melbourne, Melbourne, Australia. .,Peter MacCallum Cancer Centre, Division of Allied Health, Melbourne, Australia.
| | - Hilmy Ismail
- Peter MacCallum Cancer Centre, Department of Anaesthesia, Perioperative and Pain Medicine, Melbourne, Australia.,The University of Melbourne, Centre for Integrated Critical Care, Melbourne, Australia
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.,Physiotherapy Department, The Royal Melbourne Hospital, Melbourne, Australia
| | - Cameron Patrick
- The University of Melbourne, Statistical Consulting Centre, School of Mathematics and Statistics, Melbourne, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.,Peter MacCallum Cancer Centre, Division of Allied Health, Melbourne, Australia
| | - Bernhard Riedel
- Peter MacCallum Cancer Centre, Department of Anaesthesia, Perioperative and Pain Medicine, Melbourne, Australia.,The University of Melbourne, Centre for Integrated Critical Care, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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Abstract
OBJECTIVES We aim to describe on the role of exercise in preparation for cancer treatments (prehabilitation) that include surgery and neoadjuvant or nonsurgical approaches. We discuss the evidence for the role of exercise and provide guidelines to exercise prescription and examples of the structure of prehabilitation exercise programs. DATA SOURCE We use peer-reviewed articles obtained through PubMed searches with search terms: exercise, oncology, cancer surgery, exercise physiology, respiratory exercises, prehabilitation, and behavior change. CONCLUSION The emergence of prehabilitation in preparing patients for cancer care has followed a rapidly upward trajectory over the past 20 years. Exercise prehabilitation remains the cornerstone of management, particularly in patients attending for major surgery. Multimodal approaches to supporting patients before cancer treatment are now well accepted and include screening and individualized treatments of functional, nutritional, and psychological impairments. Respiratory training before surgery and the addition of behavior change strategies to improve adherence to interventions and promote improved longer-term outcomes are now included in many prehabilitation programs. For exercise to be an effective treatment in improving fitness and strength, supervised aerobic and resistance exercises at moderate intensity are recommended. There remains debate regarding the use of higher-intensity exercise, the appropriate outcome to measure efficacy, and the mechanisms driving the efficacy of exercise. IMPLICATIONS FOR NURSING PRACTICE We provide background evidence and knowledge pertaining to the role and provision of exercise prehabilitation. Understanding screening, risk factors, and potential efficacy assists in knowing who to refer for prehabilitation and what the programs include. This enables more effective com munication with patients attending for cancer treatments.
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Affiliation(s)
- Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences; Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Lara Edbrooke
- Department of Physiotherapy, Melbourne School of Health Sciences; Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
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Understanding Patients’ Experiences and Perspectives of Tele-Prehabilitation: A Qualitative Study to Inform Service Design and Delivery. Clin Pract 2022; 12:640-652. [PMID: 36005070 PMCID: PMC9406597 DOI: 10.3390/clinpract12040067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/21/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Tele-prehabilitation is a behaviour change intervention that facilities the modification of unhealthy lifestyle behaviours. Understanding patients’ experiences of tele-prehabilitation provides important insights into service improvement. In this study, we aimed to describe our patients’ perceptions of tele-prehabilitation and capture their capabilities, opportunities, and motivations to participate. This was a qualitative study to inform our service design and delivery. Methods: Following purposive sampling, 22 qualitative semistructured interviews were conducted with patients in the community that had completed tele-prehabilitation. Interviews were recorded and transcribed. Deductive content analysis was used to map the identified themes against theoretical determinants of health behaviour change. Results: We conducted 22 interviews. Our patients described their overall experience of tele-prehabilitation as positive and provided important insights that impacted their capabilities, opportunities, and motivations to engage with our service. Our team provided them the capabilities and self-efficacy to engage by personalising multimodal plans and setting goals. The remote delivery of our service was a recurring positive theme in providing flexibility and widening accessibility to participation. A missed opportunity was the potential for peer support through shared experiences with other patients. Patients showed greater motivation to participate for immediate perioperative benefit compared to long-term health gains. Conclusion: Patients’ experiences and perspectives of tele-prehabilitation can be enhanced by incorporating the findings from this qualitative study into service redesign and delivery. We recommend: (1) applying holistic principles in care and goal-setting, (2) delivering a combination of home-based and in-centre programmes, and (3) engaging with patients at the start of their cancer journey when they are most motivated. In turn, this can result in more effective uptake, improve adherence to interventions, and greater satisfaction.
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Steffens D, Young J, Riedel B, Morton R, Denehy L, Heriot A, Koh C, Li Q, Bauman A, Sandroussi C, Ismail H, Dieng M, Ansari N, Pillinger N, O'Shannassy S, McKeown S, Cunningham D, Sheehan K, Iori G, Bartyn J, Solomon M. PRehabIlitatiOn with pReoperatIve exercise and educaTion for patients undergoing major abdominal cancer surgerY: protocol for a multicentre randomised controlled TRIAL (PRIORITY TRIAL). BMC Cancer 2022; 22:443. [PMID: 35459100 PMCID: PMC9026022 DOI: 10.1186/s12885-022-09492-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 04/06/2022] [Indexed: 12/12/2022] Open
Abstract
Background Radical surgery is the mainstream treatment for patients presenting with advanced primary or recurrent gastrointestinal cancers; however, the rate of postoperative complications is exceptionally high. The current evidence suggests that improving patients’ fitness during the preoperative period may enhance postoperative recovery. Thus, the primary aim of this study is to establish the effectiveness of prehabilitation with a progressive, individualised, preoperative exercise and education program compared to usual care alone in reducing the proportion of patients with postoperative in-hospital complications. The secondary aims are to investigate the effectiveness of the preoperative intervention on reducing the length of intensive care unit and hospital stay, improving quality of life and morbidity, and reducing costs. Methods This is a multi-centre, assessor-blinded, pragmatic, comparative, randomised controlled trial. A total of 172 patients undergoing pelvic exenteration, cytoreductive surgery, oesophagectomy, hepatectomy, gastrectomy or pancreatectomy will be recruited. Participants will be randomly allocated to prehabilitation with a preoperative exercise and education program (intervention group), delivered over 4 to 8 weeks before surgery by community physiotherapists/exercise physiologists, or usual care alone (control group). The intervention will comprise 12 to 24 individualised, progressive exercise sessions (including aerobic/anaerobic, resistance, and respiratory exercises), recommendations of home exercises (16 to 32 sessions), and daily incidental physical activity advice. Outcome measures will be collected at baseline, the week prior to surgery, during the hospital stay, and on the day of discharge from hospital, and 1 month and 1 months postoperatively. The primary outcome will be the development of in-hospital complications. Secondary outcomes include the length of intensive care unit and hospital stay, quality of life, postoperative morbidity and costs. Discussion The successful completion of this trial will provide robust and high-quality evidence on the efficacy of a preoperative community- and home-based exercise and education intervention on important postoperative outcomes of patients undergoing major gastrointestinal cancer surgery. Trial registration This trial was registered prospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12621000617864) on 24th May 2021.
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Affiliation(s)
- Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, PO Box M157, Missenden Road, Sydney, NSW, 2050, Australia. .,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
| | - Jane Young
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Bernhard Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre and the Department of Critical Care, The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachael Morton
- Department of Health Economics & Health Technology Assessment, NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Linda Denehy
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander Heriot
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, PO Box M157, Missenden Road, Sydney, NSW, 2050, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Qiang Li
- Statistics Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Adrian Bauman
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Charbel Sandroussi
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, PO Box M157, Missenden Road, Sydney, NSW, 2050, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Hilmy Ismail
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre and the Department of Critical Care, The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Mbathio Dieng
- Department of Health Economics & Health Technology Assessment, NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nabila Ansari
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Neil Pillinger
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Sarah O'Shannassy
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sam McKeown
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre and the Department of Critical Care, The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Kym Sheehan
- Cancer Voices NSW, Sydney, New South Wales, Australia
| | - Gino Iori
- Cancer Voices NSW, Sydney, New South Wales, Australia
| | - Jenna Bartyn
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, PO Box M157, Missenden Road, Sydney, NSW, 2050, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, PO Box M157, Missenden Road, Sydney, NSW, 2050, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Shovel L, Morkane C. Prehabilitation for Vascular Surgery Patients: Challenges and Opportunities. Can J Cardiol 2022; 38:645-653. [PMID: 35240251 DOI: 10.1016/j.cjca.2022.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/24/2022] [Accepted: 02/05/2022] [Indexed: 11/02/2022] Open
Abstract
Global demand for major surgery is rising as a consequence of a growing, ageing population and clinically applicable approaches to perioperative risk reduction have never been needed more. Prehabilitation aims to optimise aerobic capacity and address modifiable risk factors prior to surgery to improve postoperative outcomes. Given the inherently high-risk nature of vascular surgery and the frequently high-acuity, frail, vascular surgical population, the potential to introduce an intervention into the surgical pathway that may reduce postoperative complications cannot be overlooked. The aim of this article is to examine the current evidence base for prehabilitation in patients awaiting vascular surgery, and to summarise the potential benefits, pitfalls, and practicalities of this emerging perioperative intervention. There is a paucity of high-quality research specifically aimed at prehabilitation for patients undergoing vascular surgery, both peripheral and aortic, making it difficult to draw definitive conclusions upon which to base a change in practice. Currently, evidence is taken from small, often single-centre heterogenous studies that vary significantly from each other, meaning that the optimal exercise regimen for patients awaiting vascular surgery has yet to be defined. Establishing the impact of prehabilitation on outcomes for vascular patients is important as the effectiveness of preoperative exercise training is likely to vary between surgical interventions and patient populations. However, extrapolation from other cohorts is possible and indeed forms the basis of many current prehabilitation programmes. Given the success of prehabilitation in other surgical groups, it has potential to become an important future research target for patients awaiting vascular surgery.
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Affiliation(s)
- Louisa Shovel
- Royal Free Perioperative Research, Department of Anaesthesia, Royal Free Hospital, Pond Street, London, UK, NW3 2QG.
| | - Clare Morkane
- Royal Free Perioperative Research, Department of Anaesthesia, Royal Free Hospital, Pond Street, London, UK, NW3 2QG
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19
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Crowe J, Francis JJ, Edbrooke L, Loeliger J, Joyce T, Prickett C, Martin A, Khot A, Denehy L. Impact of an allied health prehabilitation service for haematologic patients receiving high-dose chemotherapy in a large cancer centre. Support Care Cancer 2021; 30:1841-1852. [PMID: 34609585 PMCID: PMC8491182 DOI: 10.1007/s00520-021-06607-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022]
Abstract
Purpose Evaluate the impact of a new multidisciplinary allied health prehabilitation service 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 an allied health service for individualised exercise prescription, nutrition intervention and, if indicated through screening, psychological intervention. Impact and operational success were investigated using 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 new service had become routine practice (maintenance). Results One hundred and eighty-three patients were referred to the AuSCT service over 12 months, of whom 133 (73%) were referred into the prehabilitation service, 128 (96%) were eligible and 116 (91%) participated. Patients were representative of Australian AuSCT patients. Eighty-nine patients reached pre-transplant assessment by data censoring; 6-min walk distance (n = 45/89, 51%) improved a mean (95% CI) of 39.9 m (18.8 to 61.0, p = < 0.005) from baseline. Fidelity of exercise prescription was moderate with 72% of eligible patients receiving the intended exercise interventions. The referral trend over time (maintenance) was high after the initiation period. 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 for service improvement. Prehabilitation should be routinely considered to support patients undergoing AuSCT. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06607-w.
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Affiliation(s)
- Jessica Crowe
- Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. .,Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia.
| | - Jill J Francis
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lara Edbrooke
- Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
| | - Jenelle Loeliger
- Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Trish Joyce
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Christina Prickett
- Department of Clinical Psychology, Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Alicia Martin
- Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Amit Khot
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Linda Denehy
- Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia.,Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
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20
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Waterland JL, Chahal R, Ismail H, Sinton C, Riedel B, Francis JJ, Denehy L. Implementing a telehealth prehabilitation education session for patients preparing for major cancer surgery. BMC Health Serv Res 2021; 21:443. [PMID: 33971869 PMCID: PMC8108411 DOI: 10.1186/s12913-021-06437-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/15/2021] [Indexed: 12/31/2022] Open
Abstract
Background Prehabilitation services assist patients in preparing for surgery, yet access to these services are often limited by geographical factors. Enabling rural and regional patients to access specialist surgical prehabilitation support with the use of telehealth technology has the potential to overcome health inequities and improve post-operative outcomes. Aim To evaluate the current and likely future impact of a telehealth preoperative education package for patients preparing for major abdominal cancer surgery. Methods A telehealth alternative to a hospital based pre-operative education session was developed and implemented at a dedicated cancer hospital. Adult patients (≥18 years) scheduled for elective major cancer surgery were offered this telehealth alternative. Impact evaluation was conducted using the RE-AIM framework. Results To date, 35 participants have consented to participate in the study. Thirty-one participants attended the intervention; 24 (69%) residing in rural or regional areas. Twenty-four (77%) reported that if given a choice they would prefer the online session as opposed to attending the hospital in person. The majority (97%) reported they would recommend the intervention to others preparing for surgery. Session information was recalled by all 26 participants and 77% of participants reported acting on recommendations 2 weeks after the session. Lessons learnt and recommendations for providers implementing similar programs are reported. Conclusion Telehealth alternatives to hospital based pre-operative education are well received by patients preparing for major cancer surgery. We make seven recommendations to improve implementation. Further evaluation of implementation strategies alongside clinical effectiveness in future studies is essential. Trial registration ACTRN12620000096954, 04/02/2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06437-w.
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Affiliation(s)
- Jamie L Waterland
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia. .,Department of Physiotherapy, The University of Melbourne, Melbourne, Australia. .,Division of Allied Health, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Rani Chahal
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia
| | - Hilmy Ismail
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia
| | - Catherine Sinton
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Bernhard Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia
| | - Jill J Francis
- School of Health Sciences, The University of Melbourne, Melbourne, Australia.,Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Linda Denehy
- Division of Allied Health, Peter MacCallum Cancer Centre, Melbourne, Australia.,School of Health Sciences, The University of Melbourne, Melbourne, Australia
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21
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Waterland JL, McCourt O, Edbrooke L, Granger CL, Ismail H, Riedel B, Denehy L. Efficacy of Prehabilitation Including Exercise on Postoperative Outcomes Following Abdominal Cancer Surgery: A Systematic Review and Meta-Analysis. Front Surg 2021; 8:628848. [PMID: 33816546 PMCID: PMC8017317 DOI: 10.3389/fsurg.2021.628848] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/22/2021] [Indexed: 12/11/2022] Open
Abstract
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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Affiliation(s)
- Jamie L. Waterland
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
- Division of Allied Health, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Orla McCourt
- Cancer Institute, University College London, London, United Kingdom
| | - Lara Edbrooke
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
- Division of Allied Health, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Catherine L. Granger
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
- Physiotherapy Department, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Hilmy Ismail
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - Bernhard Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
- Division of Allied Health, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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22
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Miles LF. The end of the beginning: pre-operative intravenous iron and the PREVENTT trial. Anaesthesia 2020; 76:6-10. [PMID: 32915466 DOI: 10.1111/anae.15268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 12/13/2022]
Affiliation(s)
- L F Miles
- Centre for Integrated Critical Care, University of Melbourne, Melbourne, Australia
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23
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Steffens D, Delbaere K, Young J, Solomon M, Denehy L. Evidence on technology-driven preoperative exercise interventions: are we there yet? Br J Anaesth 2020; 125:646-649. [PMID: 32682558 PMCID: PMC7363435 DOI: 10.1016/j.bja.2020.06.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), University of Sydney, Sydney, Australia; The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Sydney, Australia.
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia (NeuRA), University of New South Wales, Sydney, Australia
| | - Jane Young
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), University of Sydney, Sydney, Australia; RPA Academic Institute of Surgery, Royal Prince Alfred Hospital (RPAH), University of Sydney, Sydney, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), University of Sydney, Sydney, Australia; The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Sydney, Australia; RPA Academic Institute of Surgery, Royal Prince Alfred Hospital (RPAH), University of Sydney, Sydney, Australia
| | - Linda Denehy
- Department of Allied Health, Peter MacCallum Cancer Centre, Melbourne, Australia; Melbourne School of Health Sciences, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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