A novel physiotherapy-led prehabilitation service: an evaluation

Abstract

Background: Prehabilitation has been shown to improve functional capacity.1 This has been demonstrated to reduce postoperative complications, hospital length of stay, and emergency admission rates.2 There is currently poor evidence on the effect on health-related quality of life.3 Methods: In 2019, University Hospitals Bristol and Weston (UHBW) set up a physiotherapy-led prehabilitation service to those listed for major surgery. Initial assessments are predominantly carried out face to face, in surgical clinics. Assessment includes screening for physical, nutritional, and psychological risk factors. Personalised exercise programmes, targeted nutritional, smoking, alcohol, and wellbeing support are provided. Follow-ups are predominately conducted over the phone on a weekly basis. Outcome measures are completed at the start and end of prehabilitation intervention. These include, 30-s sit to stand test, grip strength, and EQ5D-5L. This aims to measure overall strength, functional capacity, and health-related quality of life. Here we look at change in score from start to end of prehabilitation. Results: A total of 795 patients (average age 67 yr) have been enrolled in our prehabilitation programme in a 20-month period. Surgical specialities include: colorectal, thoracic, upper gastrointestinal, hepatobiliary, and head and neck. Data show a significant improvement in 30-s sit to stand score, average difference +2.89 (P<0.01) n=305 (Fig. 10) and a significant improvement in EQ5D index score, +0.048 (P<0.01) n=325. There was no improvement in grip strength, average difference + 0.39 kg (P=0.420) n=99. Conclusion: A personalised physiotherapy-led prehabilitation programme can improve functional capacity and health-related quality of life in patients before major surgery. Expansion of the service includes identifying patients earlier in the pathway, providing nicotine replacement therapy, and setting up group exercise classes. 1.Minnella E, Bousquet-Dion G, Awasthi R, Scheede-Bergdahl C, Carli F. Acta Oncologica 2017; 56: 295–3002.NHS South, Central and West Commissioning Support Unit. Prehad4Cancer Evaluation. 2022 (available from https://www.prehab4cancer.co.uk/wp-content/uploads/2022/01/GM_Prehab4Cancer_Evaluation_Report_Final-003.pdf (accessed 20/03/23)3.Scriney A, Russell A, Loughney L, Gallagher P, Boran L. Psychooncology 2022; 31: 2050–62