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Kan A, Page K, Devine N, Rabajoli A, Sattler L. Preoperative lifestyle modifications combined with a structured exercise protocol on patient outcomes following total knee replacement surgery: A systematic review. Musculoskeletal Care 2024; 22:e1899. [PMID: 38831384 DOI: 10.1002/msc.1899] [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: 05/08/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Medical guidelines recommend structured prehabilitation protocols consisting of lifestyle modifications and exercise to enhance post-operative outcomes for patients undergoing a total knee replacement (TKR). However, current research showing effectiveness is limited and has primarily focused on outcomes of exercise-based prehabilitation. OBJECTIVES To investigate whether a structured prehabilitation protocol consisting of exercise and lifestyle modifications improves physical function and patient-reported outcomes following TKR surgery compared with usual care. DESIGN Systematic review. METHODS Five databases were searched to identify randomised controlled trials comparing structured prehabilitation programs consisting of lifestyle modifications and exercise, with usual care, for those undergoing a TKR. Methodological quality of included studies was assessed via the RoB 2.0 tool and results synthesis via a Grading of Recommendation Assessment, Development and Evaluation approach was performed to determine the certainty evidence for each outcome. RESULTS/FINDINGS Four studies were included in this review. Despite a positive trend supporting the inclusion of a structured prehabilitation protocol, additional improvements in post-operative pain, physical function and self-reported function were only seen in one study. Reductions in hospital length of stay were also seen in one study. No additional improvements in post-operative quality of life following prehabilitation were reported. CONCLUSION Limited evidence supporting prehabilitation reported in our review is likely attributed to the intervention type, intensity, and delivery model of included studies. However, there remains to be strong evidence supporting the use of a structured prehabilitation protocol consisting of lifestyle modifications and exercise to improve post-operative outcome.
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Affiliation(s)
- A Kan
- Physiotherapy Department, Bond University, Gold Coast, Queensland, Australia
| | - K Page
- Doctor of Physiotherapy Student, Bond University, Gold Coast, Queensland, Australia
| | - N Devine
- Doctor of Physiotherapy Student, Bond University, Gold Coast, Queensland, Australia
| | - A Rabajoli
- Doctor of Physiotherapy Student, Bond University, Gold Coast, Queensland, Australia
| | - L Sattler
- Physiotherapy Department, Bond University, Gold Coast, Queensland, Australia
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Ip N, Zhang K, Karimuddin AA, Brown CJ, Campbell KL, Puyat JH, Sutherland JM, Conklin AI. Preparing for colorectal surgery: a feasibility study of a novel web-based multimodal prehabilitation programme in Western Canada. Colorectal Dis 2024; 26:534-544. [PMID: 38229235 DOI: 10.1111/codi.16851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/04/2023] [Accepted: 11/20/2023] [Indexed: 01/18/2024]
Abstract
AIM Prehabilitation for colorectal cancer has focused on exercise-based interventions that are typically designed by clinicians; however, no research has yet been patient-oriented. The aim of this feasibility study was to test a web-based multimodal prehabilitation intervention (known as PREP prehab) consisting of four components (physical activity, diet, smoking cessation, psychological support) co-designed with five patient partners. METHOD A longitudinal, two-armed (website without or with coaching support) feasibility study of 33 patients scheduled for colorectal surgery 2 weeks or more from consent (January-September 2021) in the province of British Columbia, Canada. Descriptive statistics analysed a health-related quality of life questionnaire (EQ5D-5L) at baseline (n = 25) and 3 months postsurgery (n = 21), and a follow-up patient satisfaction survey to determine the acceptability, practicality, demand for and potential efficacy in improving overall health. RESULTS Patients had a mean age of 52 years (SD 14 years), 52% were female and they had a mean body mass index of 25 kg m-2 (SD 3.8 kg m-2). Only six patients received a Subjective Global Assessment for being at risk for malnutrition, with three classified as 'severely/moderately' malnourished. The majority (86%) of patients intended to use the prehabilitation website, and nearly three-quarters (71%) visited the website while waiting for surgery. The majority (76%) reported that information, tools and resources provided appropriate support, and 76% indicated they would recommend the PREP prehab programme. About three-quarters (76%) reported setting goals for lifestyle modification: 86% set healthy eating goals, 81% aimed to stay active and 57% sought to reduce stress once a week or more. No patients contacted the team to obtain health coaching, despite broad interest (71%) in receiving active support and 14% reporting they received 'active support'. CONCLUSION This web-based multimodal prehabilitation programme was acceptable, practical and well-received by all colorectal surgery patients who viewed the patient-oriented multimodal website. The feasibility of providing active health coaching support requires further investigation.
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Affiliation(s)
- Nathanael Ip
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kexin Zhang
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ahmer A Karimuddin
- Colorectal Surgery, St Paul's Hospital, Providence Health Care, and General Surgery Residency Training Program at the University of British Columbia, Vancouver, British Columbia, Canada
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Carl J Brown
- Colorectal Surgery, St Paul's Hospital, Providence Health Care, and General Surgery Residency Training Program at the University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph H Puyat
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Jason M Sutherland
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Annalijn I Conklin
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
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Li KY, Chan PK, Yeung SS, Cheung A, Chan WKV, Luk MH, Cheung MH, Fu H, Chiu KY. The role of telemedicine in joint replacement surgery? An updated review. ARTHROPLASTY 2023; 5:39. [PMID: 37537634 PMCID: PMC10401824 DOI: 10.1186/s42836-023-00196-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/22/2023] [Indexed: 08/05/2023] Open
Abstract
The usage of telemedicine and telehealth services has grown tremendously and has become increasingly relevant and essential. Technological advancements in current telehealth services have supported its use as a viable alternative tool to conduct visits for consultations, follow-up, and rehabilitation in total joint arthroplasty. Such technology has been widely implemented, particularly during the coronavirus 2019 (COVID-19) pandemic, to deliver postoperative rehabilitation among patients receiving total joint arthroplasty (TJA), further demonstrating its feasibility with a lower cost yet comparable clinical outcomes when compared with traditional care. There remains ample potential to utilize telemedicine for prehabilitation to optimize the preoperative status and postoperative outcomes of patients with osteoarthritis. In this review, various implementations of telemedicine within total joint arthroplasty and future application of telemedicine to deliver tele-prehabilitation in TJA are discussed.
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Affiliation(s)
- Ka Yau Li
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ping Keung Chan
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China.
| | - Shun Shing Yeung
- Physiotherapy Department, MacLehose Medical Rehabilitation Centre, Hong Kong SAR, China
| | - Amy Cheung
- Department of Orthopaedics and Traumatology, Division of Joint Replacement Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Wai Kwan Vincent Chan
- Department of Orthopaedics and Traumatology, Division of Joint Replacement Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Michelle Hilda Luk
- Department of Orthopaedics and Traumatology, Division of Joint Replacement Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Man Hong Cheung
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Henry Fu
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kwong Yuen Chiu
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
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Krysa JA, Ho C, O'Connell P, Pohar Manhas K. Clinical practice recommendations for prehabilitation and post-operative rehabilitation for arthroplasty: A scoping review. Musculoskeletal Care 2022; 20:503-515. [PMID: 35165992 DOI: 10.1002/msc.1621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The rising need for arthroplasty (joint replacement) has resulted in a significant increase in wait-times. Longer surgical wait-times may further exacerbate functional decline in adults with osteoarthritis as well as delay postoperative functional recovery. This review aims to better inform rehabilitation care provision before (prehabilitation) and after (post-rehabilitation) hip or knee arthroplasty based on recommendations from clinical practice guidelines (CPGs). METHODS This scoping review used a three-stage process to screen and extract articles, which resulted in 123 articles reviewed for analysis. Included CPGs were in the English language and focussed on rehabilitation interventions or practices involving adult patients preparing for or recuperating from hip and knee arthroplasty (published 2009-2020). RESULTS Patient assessments, use of assistive devices, as well as self-management and education programs were recommended before and after arthroplasty. Physiotherapy was recommended to support post-operative rehabilitation. Conversely, there was limited evidence supporting recommendations for or against physiotherapy during the prehabilitation phase of the arthroplasty care journey. CONCLUSIONS The findings from this review highlight the current gap in high-quality evidence supporting hip and knee arthroplasty rehabilitation CPGs before and after surgery. Findings warrant additional research to ensure patients are best prepared for surgery and supported for optimal recovery.
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Affiliation(s)
- Jacqueline A Krysa
- Neurosciences, Rehabilitation and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
| | - Chester Ho
- Neurosciences, Rehabilitation and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
| | - Petra O'Connell
- Neurosciences, Rehabilitation and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Kiran Pohar Manhas
- Neurosciences, Rehabilitation and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Multimodal prehabilitation in older adults before major abdominal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 2022; 407:2193-2204. [PMID: 35233645 DOI: 10.1007/s00423-022-02479-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Multimodal prehabilitation aims to prepare frail older patients for major surgery. The objective of this review is to determine the benefits of pre-operative multimodal prehabilitation compared to standard care in older patients. METHODS Data sources included MEDLINE, EMBASE, CENTRAL, CINAHL and PsychINFO. They were searched from inception to September 2021. Only randomized controlled trials (RCT) with an average study population age ≥ 65 that had undergone major abdominal operation with at least two components (physical, nutritional, psychological) of prehabilitation programs were included. RESULTS Nine RCTs were included with a total of 823 patients, of whom 705 completed the study with 358 undergoing prehabilitation and 347 were controls. Significantly lower complications were observed in the prehabilitation group compared to control (OR 0.67; 95% CI 0.46 to 0.99; p = 0.04; I2 = 32%). A significant increase in 6-min walking distance (6MWD) from baseline to immediately prior to surgery (mean difference 35.1 m; 95%CI 11.6-58.4; p = 0.003; I2 = 67%) and 8 weeks post-surgery (mean difference 44.9 m; 95%CI 6.0-83.8; p = 0.02; I2 = 75%) was noted in the prehabilitation group. No difference was observed in length of stay (OR 0.59; 95% CI - 0.23 to 1.40; p = 0.16; I2 = 91%) or 30-day emergency department visit (OR 0.72; 95% CI 0.41 to 1.26; p = 0.25; I2 = 0%). Patient reported outcome measures were not significantly different. CONCLUSIONS Amongst older patients, multimodal prehabilitation increases peri-operative functional capacity and may potentially decrease post-operative complications. Future studies should continue to focus on older patients who are frail as this is the group that prehabilitation would likely have a clinically significant impact on.
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Alsaad R, Chen X, McAdams-DeMarco M. The clinical application of frailty in nephrology and transplantation. Curr Opin Nephrol Hypertens 2021; 30:593-599. [PMID: 34483298 PMCID: PMC8490315 DOI: 10.1097/mnh.0000000000000743] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Clinicians treating end-stage kidney disease (ESKD) and kidney transplant patients face unique challenges in their care because of the high burden of frailty in these patients. Frailty has gained significant attention by medical and surgical specialties for risk stratification in the past decades. This review highlights the importance of measuring frailty in kidney transplant candidates and recipients. RECENT FINDINGS Emerging data support that frailty is present even at younger ages among patients undergoing dialysis, transplant evaluation, or transplantation. It is estimated that 18.8% of younger (18-64 years) candidates, 25.2% of older (≥65 years) candidates, 14.3% of younger recipients, and 20.8% of older recipients are frail. Additionally, frailty is dynamic and subject to change pretransplantation and posttransplantation. Although many patients and clinicians are aware of the importance of measuring frailty, further studies addressing the need for interventions to reduce frailty burden are needed. SUMMARY Frailty is independently associated with many adverse outcomes in ESKD and kidney transplant populations. Given the growing number of ESKD and kidney transplant patients, it is pivotal to expand the utility of frailty measurement in clinical practice, recognize the burden of frailty, and identify appropriate interventions to mitigate the adverse effects of frailty.
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Affiliation(s)
- Ranim Alsaad
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mara McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Dharmasukrit C, Chan SYS, Applegate RL, Tancredi DJ, Harvath TA, Joseph JG. Frailty, Race/Ethnicity, Functional Status, and Adverse Outcomes After Total Hip/Knee Arthroplasty: A Moderation Analysis. J Arthroplasty 2021; 36:1895-1903. [PMID: 33573811 DOI: 10.1016/j.arth.2021.01.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/21/2020] [Accepted: 01/13/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although frailty has been shown to be associated with adverse outcomes in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), prior studies have not examined how race/ethnicity might moderate these associations. We aimed to assess race/ethnicity as a potential moderator of the associations of frailty and functional status with arthroplasty outcomes. METHODS The National Surgical Quality Improvement Program was queried for patients who underwent THA or TKA from 2011 to 2017. Frailty was assessed using the modified frailty index. Regression analyses were conducted to examine associations connecting frailty/functional status with 30-day readmission, adverse discharge, and length of stay (LOS). Further analyses were conducted to investigate race/ethnicity as a potential moderator of these relationships. RESULTS We identified 219,143 TKA and 130,022 THA patients. Frailty and nonindependent functional status were positively associated with all outcomes (P < .001). Compared to White non-Hispanic patients, Black non-Hispanic patients had higher odds for all outcomes after TKA (P < .001) and for adverse discharge/longer LOS after THA (P < .001). Similar associations were observed for Hispanics for the adverse discharge/LOS outcomes. Race/ethnicity moderated the effects of frailty in TKA for all outcomes and in THA for adverse discharge/LOS. Race/ethnicity moderated the effects of nonindependent function in TKA for adverse discharge/LOS and on LOS alone for THA. CONCLUSION Disparities for Black non-Hispanic and Hispanic patients persist for readmission, adverse discharge, and LOS. However, the effects of increasing frailty and nonindependent functional status on these outcomes were the most pronounced among White non-Hispanic patients.
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Affiliation(s)
- Charlie Dharmasukrit
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA
| | - Sut Yee Shirley Chan
- Psychology Department, Asian American Center on Disparities Research, University of California, Davis, Davis, CA
| | - Richard L Applegate
- Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, CA
| | - Daniel J Tancredi
- Department of Pediatrics and Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA
| | - Theresa A Harvath
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA
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Polen-De C, Langstraat C, Asiedu GB, Jatoi A, Kumar A. Advanced ovarian cancer patients identify opportunities for prehabilitation: A qualitative study. Gynecol Oncol Rep 2021; 36:100731. [PMID: 33718562 PMCID: PMC7910499 DOI: 10.1016/j.gore.2021.100731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 12/24/2022] Open
Abstract
There are multiple disease and treatment related barriers to participating in an exercise based prehabilitation program. Patients with advanced ovarian cancer are interested and motivated to take part in prehabilitation despite barriers. The oncology care team has notable influence on a patient’s motivation and willingness to participate in prehabilitation.
Prehabilitation may modify frailty and increase resilience in a subset of ovarian cancer patients; however there is low adherence to most programs. Our aim was to investigate potential barriers and facilitators of prehabilitation during neoadjuvant chemotherapy (NACT). We identified 15 patients who underwent NACT from 2016 to 2018. Patients underwent a semi-structured one-on-one interview. Transcripts were coded by 4 independent reviewers to identify emerging themes related to patients’ experience, functioning and exercise during chemotherapy. Data saturation occurred after 15 interviews. Patients had a mean age of 64 and were triaged to NACT for unresectable disease in 47% of cases. Patients were overall willing to participate in exercise during chemotherapy, including walking (93%), strength training (87%), and yoga or stretching (33%). Patients identified significant factors which would motivate them to exercise during treatment despite the stated barriers, including perceived benefit to overall health and well-being, improving cancer related outcomes and a supportive treatment community. In addition, the majority of patients cited advice from their physician to participate in an exercise program as highly motivating. Cancer and treatment related symptoms such as fatigue, pain, nausea and vomiting, and respiratory distress, as well as access to care, and social and mental barriers were most often identified by patients as barriers to exercise. Patients with advanced ovarian cancer demonstrated high motivation and willingness to exercise during chemotherapy, particularly when recommended by their healthcare team and when they believe there will be a direct benefit on treatment options or cancer cure.
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Affiliation(s)
- Clarissa Polen-De
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Carrie Langstraat
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Gladys B. Asiedu
- Mayo Clinic Kern Center for Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Corresponding author at: Division of Gynecologic Surgery and Medical Oncology, Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA.
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Almeida GJ, Khoja SS, Zelle BA. Effect of prehabilitation in older adults undergoing total joint replacement: An Overview of Systematic Reviews. CURRENT GERIATRICS REPORTS 2020; 9:280-287. [PMID: 33344110 DOI: 10.1007/s13670-020-00342-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose of Review To review and discuss the findings of systematic reviews that synthesized the evidence on the effect of preoperative exercises (prehabilitation) on postoperative functional recovery in older adults undergoing total knee or hip joint replacement. Recent Findings Ten systematic reviews (8 meta-analyses) were included in this review. Findings from the systematic reviews indicated that prehabilitation decreases length of hospital stay but does not improve postoperative functional recovery in older adults undergoing joint replacement. Individual studies in the systematic reviews varied considerably in prehabilitation protocol, assessment timepoints, and outcome measures. Most importantly, systematic reviews did not assess the outcomes pre-post prehabilitation as this timepoint was not addressed in most individual studies. Therefore, it is not known whether the prehabilitation programs improved outcomes preoperatively. Summary There is a need to develop comprehensive prehabilitation protocols and systematically assess the preoperative and postoperative effectiveness of prehabilitation protocols on functional outcomes (i.e., self-reported and performance-based) in older adults undergoing total joint replacement.
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Affiliation(s)
- Gustavo J Almeida
- Department of Physical Therapy, School of Health Professions, University of Texas Health Science Center at San Antonio; Department of Orthopaedics, Long School of Medicine, University of Texas Health Science Center at San Antonio
| | - Samannaaz S Khoja
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh
| | - Boris A Zelle
- Department of Orthopaedics, Long School of Medicine, University of Texas Health Science Center at San Antonio
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Physical Performance Tests Provide Distinct Information in Both Predicting and Assessing Patient-Reported Outcomes Following Lumbar Spine Surgery. Spine (Phila Pa 1976) 2020; 45:E1556-E1563. [PMID: 32890302 DOI: 10.1097/brs.0000000000003665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Secondary analysis of randomized controlled trial data. OBJECTIVE The aim of this study was to examine whether preoperative physical performance is an independent predictor of patient-reported disability and pain at 12 months after lumbar spine surgery. SUMMARY OF BACKGROUND DATA Patient-reported outcome measures (PROMs) are commonly used to assess clinical improvement after lumbar spine surgery. However, there is evidence in the orthopedic literature to suggest that PROMs should be supplemented with physical performance tests to accurately evaluate long-term outcomes. METHODS A total of 248 patients undergoing surgery for degenerative lumbar spine conditions were recruited from two institutions. Physical performance tests (5-Chair Stand and Timed Up and Go) and PROMs of disability (Oswestry Disability Index: ODI) and back and leg pain (Brief Pain Inventory) were assessed preoperatively and at 12 months after surgery. RESULTS Physical performance tests and PROMs significantly improved over 12 months following lumbar spine surgery (P < 0.01). Weak correlations were found between physical performance tests and disability and pain (ρ = 0.15 to 0.32, P < 0.05). Multivariable regression analyses controlling for age, education, preoperative outcome score, fusion, previous spine surgery, depressive symptoms, and randomization group found that preoperative 5-Chair Stand test was significantly associated with disability and back pain at 12-month follow-up. Each additional 10 seconds needed to complete the 5-Chair Stand test were associated with six-point increase in ODI (P = 0.047) and one-point increase in back pain (P = 0.028) scores. The physical performance tests identified an additional 14% to 19% of patients as achieving clinical improvement that were not captured by disability or pain questionnaires. CONCLUSION Results indicate that physical performance tests may provide distinct information in both predicting and assessing clinical outcomes in patients undergoing lumbar spine surgery. Our findings suggest that the 5-Chair Stand test may be a useful test to include within a comprehensive risk assessment before surgery and as an outcome measure at long-term follow-up. LEVEL OF EVIDENCE 3.
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Yau DKW, Underwood MJ, Joynt GM, Lee A. Effect of preparative rehabilitation on recovery after cardiac surgery: A systematic review. Ann Phys Rehabil Med 2020; 64:101391. [PMID: 32446762 DOI: 10.1016/j.rehab.2020.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/14/2020] [Accepted: 03/30/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Physical prehabilitation (preparative rehabilitation) programs may have beneficial effects on enhancing physical strength and functional status before surgery, but their effects on postoperative recovery are unclear. OBJECTIVES This systematic review investigated the effectiveness of physical prehabilitation programs before cardiac surgery on postoperative recovery and other perioperative outcomes. METHODS We searched for reports of randomised controlled trials of any prehabilitation programs that included physical activity or an exercise training component in adults undergoing elective cardiac surgery, published in any language, from six bibliographic databases (last search on June 20, 2019). We assessed trials for risk of bias, overall certainty of evidence and quality of intervention reporting using the Cochrane Risk of Bias Assessment Tool, GRADE system and the Template for Intervention Description and Replication checklist and guide, respectively. RESULTS All 7 studies (726 participants) were at high risk of bias because of lack of blinding. The quality of prehabilitation reporting was moderate because program adherence was rarely assessed. The timing of prehabilitation ranged from 5 days to 16 weeks before surgery and from face-to-face exercise prescription to telephone counselling and monitoring. We found uncertain effects of prehabilitation on postoperative clinical outcomes (among the many outcomes assessed): perioperative mortality (Peto odds ratio 1.30, 95% confidence interval [CI] 0.28 to 5.95; I2=0%; low-certainty evidence) and postoperative atrial fibrillation (relative risk 0.75, 95% CI 0.38 to 1.46; I2=50%; very low-certainty evidence). However, prehabilitation may improve postoperative functional capacity and slightly shorten the hospital stay (mean difference -0.66 days, 95% CI -1.29 to -0.03; I2=45%; low-certainty evidence). CONCLUSION Despite the high heterogeneity among physical prehabilitation trials and the uncertainty regarding robust clinical outcomes, physical prehabilitation before cardiac surgery seems to enhance selected postoperative functional performance measures and slightly reduce the hospital length of stay after cardiac surgery.
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Affiliation(s)
- Derek King Wai Yau
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
| | - Malcolm John Underwood
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, 7/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
| | - Gavin Matthew Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
| | - Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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Steinmetz C, Bjarnason-Wehrens B, Baumgarten H, Walther T, Mengden T, Walther C. Prehabilitation in patients awaiting elective coronary artery bypass graft surgery - effects on functional capacity and quality of life: a randomized controlled trial. Clin Rehabil 2020; 34:1256-1267. [PMID: 32546065 PMCID: PMC7477776 DOI: 10.1177/0269215520933950] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/19/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the impact of an exercise-based prehabilitation (EBPrehab) program on pre- and postoperative exercise capacity, functional capacity (FC) and quality of life (QoL) in patients awaiting elective coronary artery bypass graft surgery (CABG). DESIGN A two-group randomized controlled trail. SETTING Ambulatory prehabilitation. SUBJECTS Overall 230 preoperative elective CABG-surgery patients were randomly assigned to an intervention (IG, n = 88; n = 27 withdrew after randomization) or control group (CG, n = 115). INTERVENTION IG: two-week EBPrehab including supervised aerobic exercise. CG: usual care. MAIN MEASURES At baseline (T1), one day before surgery (T2), at the beginning (T3) and at the end of cardiac rehabilitation (T4) the following measurements were performed: cardiopulmonary exercise test, six-minute walk test (6MWT), Timed-Up-and-Go Test (TUG) and QoL (MacNew questionnaire). RESULTS A total of 171 patients (IG, n = 81; CG, n = 90) completed the study. During EBPrehab no complications occurred. Preoperatively FC (6MWTIG: 443.0 ± 80.1 m to 493.5 ± 75.5 m, P = 0.003; TUGIG: 6.9 ± 2.0 s to 6.1 ± 1.8 s, P = 0.018) and QoL (IG: 5.1 ± 0.9 to 5.4 ± 0.9, P < 0.001) improved significantly more in IG compared to CG. Similar effects were observed postoperatively in FC (6MWDIG: Δ-64.7 m, pT1-T3 = 0.013; Δ+47.2 m, pT1-T4 < 0.001; TUGIG: Δ+1.4 s, pT1-T3 = 0.003). CONCLUSIONS A short-term EBPrehab is effective to improve perioperative FC and preoperative QoL in patients with stable coronary artery disease awaiting CABG-surgery.ID: NCT04111744 (www.ClinicalTrials.gov; Preoperative Exercise Training for Patients Undergoing Coronary Artery Bypass Graft Surgery- A Prospective Randomized Trial).
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Affiliation(s)
- Carolin Steinmetz
- Institute of Sport Science, Department of Training Science and Kinesiology, University of Göttingen, Göttingen, Germany
| | - Birna Bjarnason-Wehrens
- Institute of Cardiology and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Heike Baumgarten
- Kerckhoff Heart Center, Department of Cardiothoracic Surgery, Bad Nauheim, Germany
| | - Thomas Walther
- Department of Cardiothoracic Surgery, University of Frankfurt, Frankfurt am Main, Germany
| | - Thomas Mengden
- Kerckhoff Heart Center, Department of Rehabilitation, Bad Nauheim, Germany
| | - Claudia Walther
- Department of Cardiology, University of Frankfurt, Frankfurt am Main, Germany
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Ruzycki SM, Prystajecky M, Driedger MR, Kachra R. Peri-operative cardiac biomarker screening: a narrative review. Anaesthesia 2020; 75 Suppl 1:e165-e173. [PMID: 31903570 DOI: 10.1111/anae.14920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2019] [Indexed: 12/26/2022]
Abstract
Peri-operative risk estimation has traditionally focused on assessing the likelihood of postoperative morbidity and mortality using pre-operative functional assessment. Although this strategy is currently recommended by most major society guidelines, contemporary evidence suggests that cardiac biomarker measurement has important advantages over pre-operative functional assessment. These advantages include superior predictive discrimination and inclusion of the postoperative course in risk estimation. In this review, we provide an overview of the evidence supporting the peri-operative utilisation, compare risk estimation methods and discuss which patients may benefit most from cardiac biomarker screening. We also discuss protocols for biomarker screening and management of patients with abnormal results.
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Affiliation(s)
- S M Ruzycki
- Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - M Prystajecky
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - M R Driedger
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
| | - R Kachra
- Division of General Internal Medicine, Department of Medicine, University of Calgary, AB, Canada
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Kaakinen P, Meriläinen M, Putila P, Kääriäinen M. The quality of counselling in rehabilitation evaluated by orthopaedic surgery patients at a university hospital: A cross sectional study. Int J Orthop Trauma Nurs 2019; 37:100717. [PMID: 31836417 DOI: 10.1016/j.ijotn.2019.100717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 07/03/2019] [Accepted: 09/06/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Pirjo Kaakinen
- University of Oulu, Research unit of Nursing Science and Health Management, Medical Research Center, Oulu, Finland.
| | - Merja Meriläinen
- Oulu University Hospital, Medical Research Center, Oulu, Finland.
| | - Pauliina Putila
- Department of Physical Medicine and Rehabilitation, Oulu University Hospital, Finland.
| | - Maria Kääriäinen
- University of Oulu, Research unit of Nursing Science and Health Management, Medical Research Center, Oulu, University Hospital of Oulu, Finland.
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15
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Koretz RL. JPEN Journal Club 44. When Not to Combine Data. JPEN J Parenter Enteral Nutr 2019; 43:819-821. [PMID: 30900260 DOI: 10.1002/jpen.1535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 02/26/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Ronald L Koretz
- Olive View-UCLA Medical Center, David Geffen-UCLA School of Medicine, Sylmar and Los Angeles, California, USA
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Lundberg M, Archer KR, Larsson C, Rydwik E. Prehabilitation: The Emperor's New Clothes or a New Arena for Physical Therapists? Phys Ther 2019; 99:127-130. [PMID: 30508203 DOI: 10.1093/ptj/pzy133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/04/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Mari Lundberg
- Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden; and Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Caroline Larsson
- Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg
| | - Elisabeth Rydwik
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet; and Research and Development Unit for the Elderly, FOU nu, Stockholm County Council, Stockholm, Sweden
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17
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Taylor MA, Parekh SG. Optimizing Outpatient Total Ankle Replacement from Clinic to Pain Management. Orthop Clin North Am 2018; 49:541-551. [PMID: 30224015 DOI: 10.1016/j.ocl.2018.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Outpatient total ankle arthroplasty is a potential significant source of cost savings. The ability to institute an effective outpatient total ankle program depends on appropriate patient selection, surgeon experience with total ankle replacement, addressing preoperative patient expectations, the involvement of an experienced multidisciplinary care team including experienced anesthesiologists, nurse navigators, recovery room nursing staff and physical therapists, and most importantly, such a program requires complete institutional logistical support.
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Affiliation(s)
- Michel A Taylor
- Department of Orthopaedic Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA; Duke Fuqua School of Business, 100 Fuqua Drive, Durham, NC 27708, USA; North Carolina Orthopedic Clinic, 3609 Southwest Durham Drive, Durham, NC 27707, USA.
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18
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Gillis C, Buhler K, Bresee L, Carli F, Gramlich L, Culos-Reed N, Sajobi TT, Fenton TR. Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis. Gastroenterology 2018; 155:391-410.e4. [PMID: 29750973 DOI: 10.1053/j.gastro.2018.05.012] [Citation(s) in RCA: 294] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 04/10/2018] [Accepted: 05/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Although there have been meta-analyses of the effects of exercise-only prehabilitation on patients undergoing colorectal surgery, little is known about the effects of nutrition-only (oral nutritional supplements with and without counseling) and multimodal (oral nutritional supplements with and without counseling and with exercise) prehabilitation on clinical outcomes and patient function after surgery. We performed a systemic review and meta-analysis to determine the individual and combined effects of nutrition-only and multimodal prehabilitation compared with no prehabilitation (control) on outcomes of patients undergoing colorectal resection. METHODS We searched Medline, EMBASE, CINAHL, CENTRAL, and ProQuest for cohort and randomized controlled studies of adults awaiting colorectal surgery who received at least 7 days of nutrition prehabilitation with or without exercise. We performed a random-effects meta-analysis to estimate the pooled risk ratio for categorical data and the weighted mean difference for continuous variables. The primary outcome was length of hospital stay; the secondary outcome was recovery of functional capacity based on results of a 6-minute walk test. RESULTS We identified 9 studies (5 randomized controlled studies and 4 cohort studies) composed of 914 patients undergoing colorectal surgery (438 received prehabilitation and 476 served as controls). Receipt of any prehabilitation significantly decreased days spent in the hospital compared with controls (weighted mean difference of length of hospital stay = -2.2 days; 95% confidence interval = -3.5 to -0.9). Only 3 studies reported on functional outcomes but could not be pooled owing to methodologic heterogeneity. In the individual studies, multimodal prehabilitation significantly improved results of the 6-minute walk test at 4 and 8 weeks after surgery compared with standard Enhanced Recovery Pathway care and at 8 weeks compared with standard Enhanced Recovery Pathway care with added rehabilitation. The 4 observational studies had a high risk of bias. CONCLUSIONS In a systematic review and meta-analysis, we found that nutritional prehabilitation alone or combined with an exercise program significantly decreased length of hospital stay by 2 days in patients undergoing colorectal surgery. There is some evidence that multimodal prehabilitation accelerated the return to presurgical functional capacity.
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Affiliation(s)
- Chelsia Gillis
- Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Katherine Buhler
- Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lauren Bresee
- Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University Health Center, Montreal, Quebec, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nicole Culos-Reed
- Faculty of Kinesiology and Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Tolulope T Sajobi
- Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Tanis R Fenton
- Department of Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Nutrition Services, Alberta Health Services, Calgary, Canada
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Abstract
To successfully deliver greater perioperative value-based care and to effectively contribute to sustained and meaningful perioperative population health management, the scope of existing preoperative management and its associated services and care provider skills must be expanded. New models of preoperative management are needed, which rely extensively on continuously evolving evidence-based best practice, as well as telemedicine and telehealth, including mobile technologies and connectivity. Along with conventional comorbidity optimization, prehabilitation can effectively promote enhanced postoperative recovery. This article focuses on the opportunities and mechanisms for delivering value-based, comprehensive preoperative assessment and global optimization of the surgical patient.
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Affiliation(s)
- Neil N Shah
- Department of Medicine, Dell Medical School, The University of Texas at Austin, Health Discovery Building, 1701 Trinity Street, Austin, TX 78712-1875, USA
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA; Department of Population Health, Dell Medical School, The University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA.
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Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, Boutros M, McClane J, Steele SR, Feldman LS. Clinical practice guideline for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons (ASCRS) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Surg Endosc 2017; 31:3412-3436. [DOI: 10.1007/s00464-017-5722-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/10/2017] [Indexed: 12/16/2022]
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21
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Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 2017; 60:761-784. [PMID: 28682962 DOI: 10.1097/dcr.0000000000000883] [Citation(s) in RCA: 267] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kawaguchi M, Ida M, Naito Y. The role of Perioperative Surgical Home on health and longevity in society: importance of the surgical prehabilitation program. J Anesth 2017; 31:319-324. [DOI: 10.1007/s00540-017-2329-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 02/18/2017] [Indexed: 12/19/2022]
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