Multimodal Program Research Articles

The challenges of evidence-based prehabilitation in a real-life context for patients preparing for colorectal surgery—a cohort study and multiple case analysis

BackgroundMultimodal prehabilitation programs are effective at reducing complications after colorectal surgery in patients with a high risk of postoperative complications due to low aerobic capacity and/or malnutrition. However, high implementation fidelity is needed to achieve these effects in real-life practice. This study aimed to investigate the implementation fidelity of an evidence-based prehabilitation program in the real-life context of a Dutch regional hospital.MethodsIn this observational cohort study with multiple case analyses, all patients who underwent colorectal surgery from January 2023 to June 2023 were enrolled. Patients meeting the criteria for low aerobic capacity or malnutrition were advised to participate in a prehabilitation program. According to recent scientific insights and the local care context, this program consisted of four exercise modalities and three nutrition modalities. Implementation fidelity was investigated by evaluating: (1) coverage (participation rate), (2) duration (number of days between the start of prehabilitation and surgery), (3) content (delivery of prescribed intervention modalities), and (4) frequency (attendance of sessions and compliance with prescribed parameters). An aggregated percentage of content and frequency was calculated to determine overall adherence.ResultsFifty-eight patients intended to follow the prehabilitation care pathway, of which 41 performed a preoperative risk assessment (coverage 80%). Ten patients (24%) were identified as high-risk and participated in the prehabilitation program (duration of 33–84 days). Adherence was high (84–100%) in five and moderate (72–73%) in two patients. Adherence was remarkably low (25%, 53%, 54%) in three patients who struggled to execute the prehabilitation program due to multiple physical and cognitive impairments.ConclusionImplementation fidelity of an evidence-based multimodal prehabilitation program for high-risk patients preparing for colorectal surgery in real-life practice was moderate because adherence was high for most patients, but low for some patients. Patients with low adherence had multiple impairments, with consequences for their preparation for surgery. For healthcare professionals, it is recommended to pay attention to high-risk patients with multiple impairments and further personalize the prehabilitation program. More knowledge about identifying and treating high-risk patients is needed to provide evidence-based recommendations and to obtain higher effectiveness.Trial registrationNCT06438484.

Current Physiotherapy Assessment and Treatment Practices for Low Back Pain in Nigeria: A National Survey.

Despite advances in physiotherapy care for Low Back Pain (LBP) worldwide, studies suggest that physiotherapists in Nigeria do not adhere to international guidelines, and it is not known whether recent treatment approaches developed for LBP are recognized or applied by physiotherapists in Nigeria. To evaluate the current assessment and treatment practices used by physiotherapists in Nigeria for people with recent onset, recurrent and chronic LBP. A descriptive cross-sectional electronic national survey. Two hundred and sixty-seven registered physiotherapists who treat LBP across all 36 states of Nigeria completed the survey anonymously via REDCap. Two hundred and sixty-seven physiotherapists (mean age=37.6years, SD=9.1; 53.6% female) completed the survey in full. Although most physiotherapists (>95%) regularly applied traditional assessment methods (e.g., history of presenting complaint, observation for spinal deformity, palpation), only approximately 30% screened for red flag pathology. Very few physiotherapists assessed patients with LBP for psychological distress (<8%) or risk stratification/prognostic factors (<4%). For treatment, electrophysical agents and muscle techniques (e.g., massage) predominated (>95%), while few physiotherapists used cognitive-behavioural strategies (<2%), individualised multimodal treatment programs (e.g., cognitive functional therapy, StarT Back or STOPS, <1.5%), validated outcome measures (<15%), clinical practice guidelines (<10%) or a clinical reasoning strategy/framework (<20%). Most Nigerian physiotherapists (>99%) expressed interest in learning evidence-based LBP assessment and treatment methods from international experts. There is very limited application of contemporary assessment and treatment practices for LBP by Nigerian physiotherapists; however, they are very interested in learning these methods from international experts.

Multimodal Inpatient Prehabilitation Prior to Heart or Lung Transplantation in a Latin American Transplant Reference Center.

Whether the implementation of a multimodal prehabilitation program is effective and safe for high-risk heart or lung transplantation candidates, whose condition prevents hospital discharge, is unclear. We conducted a retrospective study at a cardiothoracic transplant center in Chile. Two cohorts of hospitalized patients listed for heart or lung transplant were studied: the first underwent traditional (historical) and nonstructured prehabilitation, and the second underwent protocol-driven multimodal prehabilitation (MP). Adverse events and preoperative functional changes in the MP group were documented, as well as comparative postoperative outcomes between both cohorts. Between 2018 and 2023, 24 transplant recipients were analyzed. During the MP phase, significant improvement was observed in Medical Research Council scale (52.0 ± 7 to 58.7 ± 3; P = .042), sit-to-stand test (7.1 ± 7 to 15.9 ± 6; P = .018), and euthymic state (from 4 to 10 patients; P .036), without reported adverse events. Postoperatively, MP group demonstrated faster standing (1.9 ± 0.7 vs 1.3 ± 0.5 days; P = .05) and sitting times (2.0 ± 0.7 vs 1.2 ± 0.5 days; P = .007), with more early extubations (3 vs 11; P = .003) in comparison to the historical prehabilitation cohort. In this small retrospective study, MP in hospitalized patients awaiting heart or lung transplantation appears to be safe and associated with improvements in pre- and postoperative outcomes.

The Effects of Multimodal Exercise Program on Functional Capacity and Quality of Life in Elderly Patients with Parkinson's Disease

Introduction: Parkinson's disease (PD) is a degenerative neurological illness characterized by various motor and non-motor symptoms that can lead to varying degrees of functional impairment. This study aims to investigate the effects of a multimodal exercise program (MEP) on functional capacity and quality of life in elderly patients with PD. Methods: Thirty elderly patients with PD were randomly divided into two equal groups of MEP and control, with no significant differences in age, weight, and height. The variables of Functional Factors and Quality of Life were assessed in pre- and post-tests. MEP was performed five days a week for twelve weeks. Data were analyzed using repeated measures ANOVA at a significance level of p &lt; 0.05. Results: The study observed significant differences in quality of life, static balance, dynamic balance, wrist strength, and walking performance between the two groups of PD patients (p &lt;0.001). The mean scores of quality of life, static balance, dynamic balance, and wrist strength in the MEP group were significantly higher compared to the control group (p &lt;0.001). Additionally, after the intervention, the walking speed in the MEP group showed a significant improvement, with a lower completion time compared to the control group (p &lt;0.001). Conclusion: MEP can be used as a useful and effective method to improve quality of life, static balance, dynamic balance, wrist strength and walking performance of PD patients. Therefore, MEP (resistance, aerobic, and balance) is recommended as the most effective complementary therapeutic strategy for PD.

Impact of diagnostic stewardship on catheter-associated urinary tract infections and patient outcomes.

Diagnostic stewardship of urine cultures from patients with indwelling urinary catheters may improve diagnostic specificity and clinical relevance of the test, but risk of patient harm is uncertain. We retrospectively evaluated the impact of a computerized clinical decision support tool to promote institutional appropriateness criteria (neutropenia, kidney transplant, recent urologic surgery, or radiologic evidence of urinary tract obstruction) for urine cultures from patients with an indwelling urinary catheter. The primary outcome was a change in catheter-associated urinary tract infection (CAUTI) rate from baseline (34 mo) to intervention period (30 mo, including a 2-mo wash-in period). We analyzed patient-level outcomes and adverse events. Adjusted CAUTI rate decreased from 1.203 to 0.75 per 1,000 catheter-days (P = 0.52). Of 598 patients triggering decision support, 284 (47.5%) urine cultures were collected in agreement with institutional criteria and 314 (52.5%) were averted. Of 314 patients whose urine cultures were averted, 2 had a subsequent urine culture within 7 days that resulted in a change in antimicrobial therapy and 2 had diagnosis of bacteremia with suspected urinary source, but there were no delays in effective treatment. A diagnostic stewardship intervention was associated with an approximately 50% decrease in urine culture testing for inpatients with a urinary catheter. However, the overall CAUTI rate did not decrease significantly. Adverse outcomes were rare and minor among patients who had a urine culture averted. Diagnostic stewardship may be safe and effective as part of a multimodal program to reduce unnecessary urine cultures among patients with indwelling urinary catheters.

Changes in nutritional status and effectiveness of the dietary intervention of multimodal prehabilitation for patients with colorectal cancer: A secondary analysis of the PREHAB randomized clinical trial.

Prehabilitation is a preoperative multimodal program including exercise, nutritional, and psychological support. Little is known about changes in nutritional status during prehabilitation. This secondary analysis of the PREHAB trial aims to assess changes in nutritional status and explore the effectiveness of a four-week nutritional intervention. Data were collected at baseline and preoperatively (end of the program), including body composition with bioelectrical impedance analysis (single frequency, 50kHz), muscle strength (indirect 1RM leg press), three-day food diaries and the scored PG-SGA. Protein requirements were set at 1.5g/kg body weight. Sixty-seven participants were enrolled, 34 to standard care and 33 to four-week prehabilitation. Nutritional status improved in both groups:-1 point change in the standard care group (p=, 0.027), and-1.5 point in the prehabilitation group (p=0.015). Those who received prehabilitation statistically increased fat free mass (0.9kg, p=0.017) and appendicular skeletal muscle mass (0.5kg, p=0.007. In contrast, an increase in fat mass (0.6kg, p=0.016) was observed within the standard care group only. Participants in the prehabilitation group had a substantial increase of 27% muscle strength (p= <0.001). Optimal protein intake was more often achieved within the prehabilitation group (47%, p= <0.001). Our study provides evidence for the positive impact of multimodal prehabilitation on preoperative nutritional status in adult patients with CRC, especially in body composition and muscle strength. Achieving optimal protein intake was challenging, both dietary counseling and supplements are recommended to improve intake. PREHAB RCT: NTR5947.

Annelids‐Inspired Modular Design of Multi‐Modal Deformation for Magnetic Soft Robots

AbstractMagnetic‐responsive soft materials have found extensive applications in biomedicine, robotics, and bionics. They can achieve complex deformations through structural design, magnetization patterns, and driving magnetic fields. However, due to the infinite degrees of freedom in soft materials, more efficient design methods for magnetic soft materials need to be explored. Here, a multimodal unit programming method is proposed for designing hard magnetic soft materials. The structure of the multimodal units is inspired by the segmented structure of earthworms. By altering the combination of single‐tube units, the dual‐tube units exhibit specific deformation modes. This approach simplifies the complex deformation of magnetic soft materials into the single deformations of units, enabling facile programming design of magnetic soft materials. The application of different deformation modes is demonstrated in various scenarios and scale down the units to one‐tenth of their original size for operations at different scales. This further uncovering the potential of magnetic soft materials and providing ideas for their efficient design.

Enhancing the psychological well-being and sleep quality of healthcare providers with a multimodal psychological support program: a randomized controlled trial.

The COVID-19 pandemic significantly challenged the global healthcare system, especially frontline healthcare professionals, such as those working in intensive care units (ICUs). In late 2022, a sudden increase in COVID-19 cases in China led to a large number of ICU admissions, requiring new ICU staff (non-ICU professionals to work in ICUs), exacerbating their stress. This study aimed to develop an effective stress management strategy for new ICU professionals, focusing on reducing the detrimental effects of stress on their psychological state. We hypothesized that the online multimodal psychological support (MPS) program might improve the psychological well-being and sleep quality of the participants. This single-center, single-blind randomized controlled trial included new ICU staff during the COVID-19 pandemic. Participants were randomly assigned to either an intervention (online psychological support, MPS) or a control (routine wellness care, RWC) group for 28 days, and assessments were conducted before intervention (baseline), after intervention, and at the 1-month follow-up. The intervention included music therapy, sleep hygiene education, psychoeducation, and relaxation training, tailored to address common psychiatric issues experienced by healthcare professionals during the pandemic. The primary outcome was a DASS-21 score 28 days after the end of the intervention. One hundred and one professionals eventually participated in the study, 47 in the MPS group and 54 in the RWC group. No significant differences were observed in the overall psychological well-being immediately after the end of the intervention. However, the MPS group showed improved sleep and sustained lower stress levels, anxiety, and depression scores at the 1-month follow-up, significantly improving the severity of insomnia (marginal mean difference -2.028; SE 1.00; p = 0.044). The online multimodal psychological support program effectively enhanced the psychological well-being and sleep quality of new ICU staff demonstrating the potential of off line training in managing stress and improving health outcomes during crises. The findings of this study emphasize the importance of accessible, flexible psychological support, especially in high-stress environments such as ICUs during pandemics.

Improvements of depression, anxiety, stress, and social support through a telerehabilitation system in discharged COVID-19 patients: a randomized controlled pilot study

ABSTRACT Introduction Post-acute COVID-19 patients who were discharged from hospitals during the epidemic faced significant challenges, not only physical sequelae, but also psychological distress, anxiety, and depression. It is already known that continued exercise improves psychosocial components, but few studies have explored the impact of multimodal rehabilitation programs, including therapeutic education, in this type of patient. There are no studies that explore the application of these programs through asynchronous telerehabilitation, which would open up new therapeutic windows. Methods This pilot single-blinded randomized controlled trial included 35 post-discharge COVID-19 patients allocated to two intervention arms: an asynchronous telerehabilitation group (ATG) and a booklet-based rehabilitation group (BRG). The aim was to analyze the preliminary changes in depression, anxiety, stress, and social support comparing both groups. Results The ATG exhibited statistically significant reductions in depression (p = 0.048) and stress (p = 0.033) compared to the BRG after intervention. While both groups showed improvements in psychosocial variables, the ATG demonstrated consistent lower depression levels at 3- and 6-month follow-ups (p = 0.010, p = 0.036 respectively) and notably higher social support at 3- and 6-month follow-ups (p = 0.038, p = 0.028 respectively). Discussion This pilot study suggests that a multimodal rehabilitation program using asynchronous telerehabilitation provides substantial benefits in terms of alleviating psychological distress and improving social support in discharged COVID-19 patients. These data will enable for larger studies to confirm these results.

Evaluating the Impact of Multimodal Prehabilitation with High Protein Oral Nutritional Supplementation (HP ONS) with Beta-Hydroxy Beta-Methylbutyrate (HMB) on Sarcopenic Surgical Patients-Interim Analysis of the HEROS Study.

Multimodal prehabilitation programs, which may incorporate nutritional supplementation and exercise, have been developed to combat sarcopenia in surgical patients to enhance post-operative outcomes. However, the optimal regime remains unknown. The use of beta-hydroxy beta-methylbutyrate (HMB) has beneficial effects on muscle mass and strength. However, its effect on muscle quality in the perioperative setting has yet to be established. This study aims to explore the impact of a multimodal prehabilitation program using a bundle of care that includes high-protein oral nutritional supplementation (HP ONS) with HMB and resistance exercise on muscle quality and functional outcomes in sarcopenic surgical patients. Sarcopenic adult patients undergoing elective major gastrointestinal surgeries were recruited for this pilot interventional cohort study. They were enrolled in a 2-4-week multimodal prehabilitation program comprising resistance exercise, nutritional supplementation, vitamin supplementation, comorbid optimization and smoking cessation. Participants were provided three units of HP ONS with HMB per day pre-operatively. The primary outcome was changes in intramuscular adipose tissue (IMAT) as a proxy of muscle quality, assessed using Artificial Intelligence (AI)-aided ultrasonography. Secondary outcomes include changes in anthropometric measurements and functional characteristics. Outcomes were measured before prehabilitation, after prehabilitation and 1 month post-operatively. A total of 36 sarcopenic patients, with a median age of 71.5 years, were included in this study. There was an increase in the IMAT index after two weeks of prehabilitation (p = 0.032) to 1 month after surgery (p = 0.028). Among functional parameters, improvement was observed in gait speed (p = 0.01) after two weeks of prehabilitation, which returned to baseline post-operatively. The median length of hospital stay was 7 (range: 2-75) days. The increase in the IMAT index in a sarcopenic surgical cohort undergoing prehabilitation may be due to altered muscle metabolism in elderly sarcopenic patients. A prehabilitation regime in sarcopenic patients incorporating HP ONS with HMB and resistance exercise is feasible and is associated with increased gait speed.

Emotional Regulation Competencies for People With Type 1 Diabetes Mellitus (T1D) – A Multimodal Training Program (Current State)

Emotional Regulation Competencies for People With Type 1 Diabetes Mellitus (T1D) – A Multimodal Training Program (Current State)

Multimodal prehabilitation combined with perioperative enhanced recovery after surgery care for older patients undergoing spinal fusion surgery in China: protocol for a multicentre randomised controlled trial (PRACTICE trial)

IntroductionBesides the comorbid risk factors shared by older and younger patients, older individuals may also experience malnutrition, as well as cognitive or functional impairments. The accumulation of frailty and various...

Bridging the Gap: Understanding Patient and Clinician Preferences When Designing Preoperative Education Programs.

Traditionally, health information has been created from the perspective of the providers with minimum patient consultation, hindering engagement and adherence. The rate of shoulder replacements has increased over the past decade, is associated with shorter hospital stays, and patients are relying on education to be able to participate in shared decision-making. Therefore, to ensure creation of accessible education programs for shoulder replacement procedures, we explored patient and clinician preferences regarding content and device choices for a preoperative shoulder replacement education program. This study used an interpretive descriptive qualitative approach to understand patient and clinician preferences. We included a subset of patient and healthcare provider perspectives, from those who had previously completed our quantitative survey. Interviews were conducted in English by one researcher. Analysis was conducted through a descriptive thematic analysis with open coding. A total of 10 patients and 9 healthcare providers were interviewed. Findings were categorized into four main themes described the process of creating patient education material (1) methods of accessing information, (2) deciding on educational content, (3) deciding on device use, and the last theme of factors affecting engagement can be further divided as (4-1) promotors of engagement and (4-2) barriers of engagement. A multimodal program of a website with videos and a written booklet, that covers basic information regarding the surgery, timelines for recovery, sling use, use of therapeutic devices/aids post-surgery, patient expectations to improve surgery satisfaction, postoperative restrictions, pain management, rehabilitation and home supports is desired by both patients and clinicians.

Unruly subjects: The subaltern struggle for media justice, multimodality, and autoethnography in academia and beyond

AbstractIn this autoethnographic article, I explore the “crisis of representation” and the struggle of subaltern people for reparative representation and media justice. I argue that the field of visual anthropology and its multimodal programs have emerged from the margins to be at the forefront of decolonizing media and representation in the academy and beyond, but more work still needs to be done to achieve parity. I highlight the work and programs of leading scholar‐practitioners and their methodological and theoretical approaches that have shifted the paradigm of modern anthropology and representational politics and practice more generally. I focus on the trajectory of Faye Ginsburg's scholarship and media activism working with Indigenous, disability, and reproductive justice movements and show its impact on my work in the media worlds of the United States and Afghanistan and on Middle Eastern and Asian contexts and studies more broadly.

Long -term multimodal exercise intervention for patients with frontotemporal lobar degeneration: Feasibility and preliminary outcomes

Introduction: After Alzheimer's disease, frontotemporal lobar degeneration (FTLD) is the second most common form of early-onset dementia. Despite the heavy burden of care for FTLD, pharmacological and non-pharmacological treatments with sufficient efficacy remain scarce. This study aimed to evaluate the feasibility of a multimodal exercise program for FTLD and to examine preliminary changes in the clinical outcomes of the program in FTLD. Methods: This single-arm preliminary study was conducted from July 2017 to July 2018 and recruited four male patients with FTLD aged 60–78 years. Patients exercised under the supervision of an exercise instructor once every 2 weeks for 48 weeks. The multimodal exercise program comprised cognitive training, moderate-intensity continuous training, strength training, balance training, and flexibility and relaxation training. Feasibility was measured using dropout and attendance rates. Cognitive, psychological, physical, and behavioral function tests were conducted before and after the intervention. Results: All patients completed the intervention (100%) and attended well (93.6%). Positive changes in scores in the Stroop Color Word Test (cognitive; 5 out of 6 items), Mood Check List-short form 2 (psychological), movement subscales of the Stereotypy Rating Inventory (behavioral), and timed up-and-go (TUG, physical) assessments demonstrated a medium-to-high effect size (open effect size: 0.52–0.97). While there were improvements in some domains, such as recovery self-efficacy and exercise efficacy, the MMSE-J scores showed an overall slight decline, especially in the SD case where a marked decrease was observed. Additionally, three physical function items showed no effect, except for a positive outcome in the TUG test. Functional near-infrared spectroscopy (fNIRS) revealed increased activation in the frontal lobe, indicated by elevated oxygenated hemoglobin levels before and after the exercise intervention. This pattern of activation suggests that the intervention may have stimulated neural activity in the frontal lobe, potentially enhancing cognitive and behavioral functions, including executive function and attention. Conclusion: The long-term multimodal exercise intervention may be feasible and positively change the cognitive, psychological, physical, and behavioral functions in older adults with FTLD. Although the intervention led to improvements in certain areas, there were also declines observed in various functions, which may not necessarily be due to the intervention itself but rather reflect the natural progression of the disease.

Promoting Psychological Health and Overall Wellness in Female Veterans With Military Sexual Trauma Through Complementary Health Interventions: A Quality Improvement Project.

Military sexual trauma (MST) has been associated with long-term negative outcomes such as increased rates of cardiovascular disease, post-traumatic stress disorder (PTSD), and suicidal thoughts and behaviors. While evidence supports the effectiveness of psychotherapeutic approaches as treatments for MST and related PTSD symptoms, these interventions have limited impact, attributed to perceived stigma with high dropout rates in female Veterans. Complementary and integrative health (CIH) interventions provide an alternative that may be more acceptable and can help transition Veterans into mental health treatments. Although evidence supports the utility of individual CIH interventions to be both effective and acceptable treatments for MST-related PTSD amongst female Veterans, there are limited evaluations of interventions that combine multiple CIH modalities, specifically in populations of at-risk female Veterans with histories of suicidal ideation or behavior. Thus, this quality improvement (QI) project aimed to assess the impact of a multimodal CIH intervention on mental and physical health symptoms specifically in female at-risk Veterans with MST. A total of 19 female Veterans with histories of MST and suicidal ideation and/or behavior who participated in an interventional programming in an urban VA in New York City were included in a secondary analysis for QI evaluation. These female Veterans comprised a subset of participants who previously engaged in a larger QI multimodal CIH intervention delivered over 4-week long in a cohort setting during which Veterans (both males and females) engaged in meditation and mindfulness, physical exercise, nutrition, and motivational curricula. Integrated as part of this programming, mental health symptoms (i.e., depression, PTSD, and stress/anxiety) and other factors related to suicide risk were assessed before and after program participation for all participants. Improvements across these symptoms pre- vs. post-program participation were examined. For this secondary analysis, a total of 73% of females with MST who participated in the multimodal CIH interventional programming had a prior history of suicidal ideation or behavior. These participants showed elevated levels of depression and sleep disturbance symptoms at baseline prior to engagement in the multimodal CIH interventions, with medium-to-large reductions in these symptoms following completion of the multimodal CIH programming (Cohen's d > 0.61 magnitude differences in symptom reduction pre vs. post). The results of this QI evaluation add to the growing body of evidence demonstrating that CIH interventions can be effective in attenuating mental health symptom-related MST and particularly within female Veteran populations at-risk for suicide, underscoring the potential importance of investigating integration of multiple CIH interventions for treatment of at-risk populations in future clinical research studies.

Incremental versus saturation hypotheses for behavioral nudge in reducing sugar consumption.

This field experiment examined the efficacy of a behavioral nudge intervention towards lowering sugar intake in Indonesia. Specifically, two competing hypotheses were tested as to whether behavioral nudge played an additive role (i.e., the Incremental Hypothesis) or contributed to a ceiling effect (i.e., the Saturation Hypothesis) alongside social context and competition in a multimodal intervention program. This field experiment used a three-factorial mixed design involving 403 Indonesian participants based on power statistical analysis: 2 (sugar content nudge: lower sugar tea vs. regular sugar tea default) × 2 (social context: individual vs. group) × 2 (competition: absent vs. present). Nudging was the most powerful intervention in reducing sugar intake, but its effectiveness might be attenuated by social loafing even within Indonesia's collectivist culture. Competition did not work synergistically with nudging but was effective under the nonnudge condition. Our results are consistent with those of previous research showing that behavioral nudging has a stronger impact on behavioral change than nonnudge strategies. Contrary to some previous research, people in collectivist Indonesia did engage in social loafing: achievement motivation is not necessarily enhanced in a team of people in a collectivist culture. The Nudge × Competition interaction supports the saturation hypothesis in favor of behavioral nudging: using more than one intervention, when a potent strategy such as nudging is present, might result in diminishing returns that could reduce the overall benefit-cost profile of such multimodal intervention programs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Multimodal Patient-Centered Teleprehabilitation Approach for Patients Undergoing Surgery for Breast Cancer: A Clinical Perspective.

Breast cancer is the most common malignancy among women worldwide, and advances in early detection and treatment have significantly increased survival rates. However, people living beyond breast cancer often suffer from late sequelae, negatively impacting their quality of life. Prehabilitation, focusing on the period prior to surgery, is a unique opportunity to enhance oncology care by preparing patients for the upcoming oncological treatment and rehabilitation. This article provides a clinical perspective on a patient-centered teleprehabilitation program tailored to individuals undergoing primary breast cancer surgery. The proposed multimodal program includes three key components: patient education, stress management, and physical activity promotion. Additionally, motivational interviewing is used to tailor counseling to individual needs. The proposed approach aims to bridge the gap between diagnosis and oncological treatment and provides a holistic preparation for surgery and postoperative rehabilitation in breast cancer patients. The aim of this preparation pertains to improving mental and physical resilience. By integrating current evidence and patient-centered practices, this article highlights the potential for teleprehabilitation to transform clinical care for breast cancer patients, addressing both logistical challenges and holistic well-being.

Initial participant perspectives about participating in an online, semi-supervised, cirrhosis-specific nutrition and exercise intervention.

In chronic diseases, there have been issues with low levels of participant adherence and retention during well-supported lifestyle behaviour change interventional studies. Theoretically informed, the objective was to explore the types of challenges participants are experiencing to inform future designs. We conducted an exploratory descriptive study in an adult cirrhosis population after the first 4-6 weeks of a 12-week semi-supervised nutrition and exercise online program. Participants in the parent feasibility study, assessing the nutrition and exercise intervention (Heal-Me), were eligible for this nested study. Heal-Me is a multimodal program that is tailorable to a participant's abilities through regular interaction with the study's registered dietician and exercise specialist. Interviews (~60 min) with participants were recorded then analysed descriptively, guided by the capability, opportunity and motivational behaviour change model. The 20 participants preferred the expert-led group online nutrition and exercise classes over independent activities such as protein tracking and the exercise videos. Social gamification (e.g., weekly polls on favourite things like movies or sports teams) contributed to the group experience. All except one person required program tailoring to address preferences, abilities and new onset health events. Findings led to the inclusion of 4 behaviour change techniques to the initial 17, whereas 2 others were expanded. While program tailoring, awareness of cirrhosis nutrition and regular interactions with staff influenced participant retention and adherence in the first 4-6 weeks of the online program.

Co-developing a theory of change for a personalised multimodal cancer prehabilitation programme in South Wales

BackgroundEvidence suggests that prehabilitation interventions, which optimise physical and mental health prior to treatment, can improve outcomes for surgical cancer patients and save costs to the health system through faster recovery and fewer complications. However, robust, theory-based evaluations of these programmes are needed. Using a theory of change (ToC) approach can guide evaluation plans by describing how and why a programme is expected to work. Theories of Change have not been developed for cancer prehabilitation programmes in the literature to date. This paper aims to provide an overview of the methodological steps we used to retrospectively construct a ToC for Prehab2Rehab (P2R), a cancer prehabilitation programme being implemented by the Cardiff and Vale University Health Board.MethodsWe used an iterative, participatory approach to develop the ToC. Following a literature review and document analysis, we facilitated a workshop with fourteen stakeholders from across the programme using a ‘backwards mapping’ approach. After the workshop, stakeholders had three additional opportunities to refine and validate a final working version of the ToC.ResultsOur process resulted in the effective and timely development of a ToC. The ToC captures how P2R’s interventions or activities are expected to bring about short, medium and long-term outcomes that, collectively, should result in the overarching desired impacts of the programme, which were improved patient flow and reduced costs to the health system. The process of developing a ToC also enabled us to have a better understanding of the programme and build rapport with key stakeholders.ConclusionsThe ToC has guided the design of an evaluation that covers the complexity of P2R and will generate lessons for policy and clinical practice on supporting surgical cancer patients in Wales and beyond. We recommend that evaluators apply a ToC development process at the outset of evaluations to bring together stakeholders and enhance the utilisation of the findings. This paper details a pragmatic, efficient and replicable process that evaluators could adopt to develop a ToC. Theory-informed evaluations may provide better evidence to develop and refine cancer prehabilitation interventions and other complex public health interventions.