Barriers and Facilitators in Rehabilitation in Chronic Diseases and After Surgery: Is It a Matter of Adherence?

Elijah E Sanches,James Navalta,Tomasz Kostka,Sjaak Pouwels,Nasser Sakran,Emily Aupers

doi:10.7759/cureus.20173

Abstract

Although it has been generally acknowledged that participating in rehabilitation programs is better for chronic diseases or post-surgery, the adherence rates of these programs remain lower than expected. According to the World Health Organization (WHO), adherence has been defined as follows: "the extent to which a person's behavior corresponds with agreed recommendations from a healthcare provider." In general, rehabilitation is well investigated, and in chronic diseases like chronic obstructive pulmonary disease (COPD), cardiovascular disease, neuromuscular disease, cancer, and even psychiatric diseases like depression, it has been shown that exercise therapy, in particular, has beneficial effects on morbidity, mortality, and convalescence of these patients. The aim of this review is to give an overview of the barriers and facilitators in rehabilitation practices and possible reasons why adherence rates remain low. Regarding potential future research, barriers and facilitators also need to be taken into account. Despite promising research in the field of preoperative exercise therapy (PET) and preoperative rehabilitation (prehab) and the enormous body of evidence in postoperative rehabilitation or rehabilitation in chronic diseases, it is also needed to take into account the accessibility of these prehab facilities in research and in clinical practice.

Highlights

Background participation in rehabilitation programs has shown effectiveness in patient outcomes in chronic diseases and postoperative care, adherence rates remain lower than expected [1]
Barriers and facilitators need to be taken into account
Almost all the studies showed that these rehabilitation programs could positively affect patient outcomes, but the adherence rates are still too low

Summary

Introduction

Participation in rehabilitation programs has shown effectiveness in patient outcomes in chronic diseases and postoperative care, adherence rates remain lower than expected [1]. Implementation of the rehabilitation program is especially important in patients with frailty syndrome and sarcopenia [24] The occurrence of these syndromes is associated with a higher risk of intraoperative and postoperative complications, higher mortality, longer hospitalization after surgery, and higher care costs. There are reports that programs conducted before surgery (three to eight weeks) primarily based on exercise and dietary interventions increase patients' functional reserves and improve the operative results and reduce the risk of complications. This form of rehabilitation has certain system-specific, practical, and patient-specific barriers to overcome

Conclusions

Disclosures

Findings

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