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Li X, Sha L, He Y, Yi J, Wang X. The impact of short-term multimodal prehabilitation on functional capacity in patients with gynecologic malignancies during the perioperative period: A prospective study. Eur J Oncol Nurs 2024; 70:102577. [PMID: 38636115 DOI: 10.1016/j.ejon.2024.102577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/14/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE To explore the effect of a short-term, hospital-based, multimodal preoperative prehabilitation intervention on perioperative functional ability of patients with gynecological malignant tumors. METHODS According to the order in which they underwent surgery, 97 patients were divided into the control group (48 cases) and the intervention group (49 cases). The control group was given routine preoperative guidance, whereas the intervention group was given short-term multimodal prehabilitation guidance on the basis of the control group intervention. The 6-min walk test was performed on the day of admission to the hospital, the day before surgery, and the 30th day after surgery. RESULTS Compared with the control group, the intervention group had significantly better 6-min walk distance and superior physical and psychological status on the day before surgery and the 30th day after surgery (P < 0.001). For three consecutive days after surgery, the quality of recovery in the intervention group was significantly higher than that in the control group (P < 0.001), and the first ambulation time and exhaust time were achieved earlier in the intervention group than in the control group (P < 0.05). CONCLUSION The preoperative intervention group showed improved preoperative exercise ability and reduced anxiety in patients with gynecological cancer. Furthermore, this intervention improved the overall health of patients and accelerated their postoperative recovery.
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Affiliation(s)
- Xin Li
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, 116021, China
| | - Liyan Sha
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, 116021, China
| | - Yang He
- School of Nursing, Dalian Medical University, Dalian, 116044, China
| | - Jing Yi
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, 116021, China
| | - Xiaorun Wang
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, 116021, China.
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Estrada DML, de Queiroz FL, Guerra LI, França-Neto PR, Lacerda-Filho A, de Miranda Silvestre SC, Coelho JM. Comparative study using propensity score matching analysis in patients undergoing surgery for colorectal cancer with or without multimodal prehabilitation. Int J Colorectal Dis 2023; 38:256. [PMID: 37878018 DOI: 10.1007/s00384-023-04547-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION The complication rate after major abdominal surgery is from 35 to 50%. The multimodal prehabilitation covers all the pre-operative problems to guarantee a faster recovery and reduce the rate of morbidity and mortality after a colorectal procedure. METHODS Observational study, in patients with CRC who underwent surgical treatment between November 2020 and September 2022. The data of the patients were placed in 2 groups: prehabilitation group (PPH) and no prehabilitation group (NPPH). Demographic data, type of cancer, operative data, and postoperative data were collected. Characteristics between the groups were compared after a propensity score matching (PSM) analysis for the detection of differences. RESULTS After the PSM analysis, 46 patients were in PPH, and 63 patients were in NPPH. There was no significant difference in postoperative complications (p = 0.192). The median of comprehensive complication index (CCI) was 0 (p = 0.552). Patients in the NPPH had more hospital readmissions (p = 0.273) and more emergency room visits (p = 0.092). Multivariate log binomial regression adjusted for complications showed that pre-habilitation reduces the risk of a pos-operative complication (OR: 0.659, 95%CI, 0.434-1.00, p = 0.019). CONCLUSIONS The postoperative complication rate and LOS were similar between patients who receive operative multimodal prehabilitation for CRC surgery and those who did not. Prehabilitation was associated with reduced risk of postoperative complication after multivariate log binomial regression adjusted for complications. Patients who underwent prehabilitation had a slightly lower tendency for postoperative ER visits and hospital readmissions.
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Affiliation(s)
- Daniel Mauricio Londoño Estrada
- Department of Colorectal Surgery, Felicio Rocho Hospital, Av. do Contorno 9530-Barro Preto, Rua Tenente Brito Melo 496, Belo Horizonte, MG, CEP 30180070, Brazil.
| | - Fábio Lopes de Queiroz
- Department of Colorectal Surgery, Felicio Rocho Hospital, Av. do Contorno 9530-Barro Preto, Rua Tenente Brito Melo 496, Belo Horizonte, MG, CEP 30180070, Brazil
| | - Luiza Iannotta Guerra
- Department of Colorectal Surgery, Felicio Rocho Hospital, Av. do Contorno 9530-Barro Preto, Rua Tenente Brito Melo 496, Belo Horizonte, MG, CEP 30180070, Brazil
| | - Paulo Rocha França-Neto
- Department of Colorectal Surgery, Felicio Rocho Hospital, Av. do Contorno 9530-Barro Preto, Rua Tenente Brito Melo 496, Belo Horizonte, MG, CEP 30180070, Brazil
| | - Antônio Lacerda-Filho
- Department of Colorectal Surgery, Felicio Rocho Hospital, Av. do Contorno 9530-Barro Preto, Rua Tenente Brito Melo 496, Belo Horizonte, MG, CEP 30180070, Brazil
- Department of Surgery, Federal University of Minas Gerais School of Medicine, Av. Prof. Alfredo Balena, 190-Santa Efigênia, Belo Horizonte, Brazil
| | | | - Jose Marcos Coelho
- Department of Anesthesiology, Felicio Rocho Hospital, Av. do Contorno, 9530-Barro Preto, Belo Horizonte, Brazil
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Molenaar CJL, Reudink M, Sabajo CR, Janssen L, Roumen RMH, Klaase JM, Slooter GD. Prehabilitation for patients with colorectal cancer: a snapshot of current daily practice in Dutch hospitals. Perioper Med (Lond) 2023; 12:15. [PMID: 37158927 PMCID: PMC10165784 DOI: 10.1186/s13741-023-00299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Multimodal prehabilitation programmes are increasingly being imbedded in colorectal cancer (CRC) pathways to enhance the patient's recovery after surgery. However, there is no (inter)national consensus on the content or design of such a programme. This study aimed to evaluate the current practice and opinion regarding preoperative screening and prehabilitation for patients undergoing surgery for CRC throughout the Netherlands. METHODS All regular Dutch hospitals offering colorectal cancer surgery were included. An online survey was sent to one representative colorectal surgeon per hospital. Descriptive statistics were used for analyses. RESULTS Response rate was 100% (n = 69). Routine preoperative screening of patients with CRC for frailty, diminished nutritional status and anaemia was the standard of care in nearly all Dutch hospitals (97%, 93% and 94%, respectively). Some form of prehabilitation was provided in 46 hospitals (67%) of which more than 80% addressed nutritional status, frailty, physical status and anaemia. All but two of the remaining hospitals were willing to adopt prehabilitation. The majority of the hospitals offered prehabilitation to specific subgroups of patients with CRC, such as the elderly (41%), the frail (71%) or high-risk patients (57%). There was high variability in the setting, design and content of the prehabilitation programmes. CONCLUSIONS Whereas preoperative screening is sufficiently incorporated in Dutch hospitals, standardised enhancement of the patient's condition in the context of multimodal prehabilitation seems to be challenging. This study presents an overview of current clinical practice in the Netherlands. Uniform clinical prehabilitation guidelines are vital to diminish heterogeneity in programmes and to produce useful data to enable a nationwide implementation of an evidence-based prehabilitation programme.
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Affiliation(s)
| | - Muriël Reudink
- Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands.
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Charissa R Sabajo
- Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Loes Janssen
- Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Rudi M H Roumen
- Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Joost M Klaase
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Gerrit D Slooter
- Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands
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Liu Y, Liu Z, Zhang Y, Cui Y, Pei L, Huang Y. The protocol for the prehabilitation for thoracic surgery study: a randomized pragmatic trial comparing a short home-based multimodal program to aerobic training in patients undergoing video-assisted thoracoscopic surgery lobectomy. Trials 2023; 24:194. [PMID: 36922827 PMCID: PMC10017060 DOI: 10.1186/s13063-023-07220-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/06/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Prehabilitation has been shown to have a positive effect on the postoperative recovery of functional capacity in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy. The optimal way to implement prehabilitation programs, such as the optimal forms of prehabilitation, duration, intensity, and methods to improve compliance, remained to be studied. This Prehabilitation for Thoracic Surgery Study will compare the effectiveness of multimodal and aerobic training-only programs in patients undergoing thoracoscopic lobectomy. METHODS This randomized pragmatic trial will be conducted in Peking Union Medical College Hospital (PUMCH) and include 100 patients who are eligible to undergo VATS lobectomy. Patients will be randomized to a multimodal or aerobic training group. Prehabilitation training guidance will be provided by a multidisciplinary care team. The patients in the multimodal group will perform aerobic exercises, resistance exercises, breathing exercises, psychological improvement strategies, and nutritional supplementation. Meanwhile, the patients in the aerobic group will conduct only aerobic exercises. The interventions will be home-based and supervised by medical providers. The patients will be followed up until 30 days after surgery to investigate whether the multimodal prehabilitation program differs from the aerobic training program in terms of the magnitude of improvement in functional capability pre- to postoperatively. The primary outcome will be the perioperative 6-min walk distance (6MWD). The secondary outcomes will include the postoperative pulmonary functional recovery status, health-related quality of life score, incidence of postoperative complications, and clinical outcomes. DISCUSSION Prehabilitation remains a relatively new approach that is not widely performed by thoracic surgery patients. The existing studies mainly focus on unimodal interventions. While multimodal prehabilitation strategies have been shown to be preferable to unimodal strategies in a few studies, the evidence remains scarce for thoracic surgery patients. The results of this study will contribute to the understanding of methods for thoracoscopic lobectomy patients. TRIAL REGISTRATION ClinicalTrials.gov NCT04049942 . Registered on August 8, 2019.
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Affiliation(s)
- Yuchao Liu
- Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, 100730, China
| | - Zijia Liu
- Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, 100730, China.
| | - Yuelun Zhang
- Department of Medical Research Center, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, 100730, China
| | - Yushang Cui
- Department of Thoracic Surgery, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, 100730, China
| | - Lijian Pei
- Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, 100730, China
| | - Yuguang Huang
- Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, 100730, China
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Gurunathan U, Tronstad O, Stonell C. Patient characteristics and preferences for a surgical prehabilitation program design: results from a pilot survey. J Cancer Res Clin Oncol 2023; 149:1361-7. [PMID: 36283998 DOI: 10.1007/s00432-022-04420-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/13/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Surgical prehabilitation aims to reduce a decline in the functional capacity thereby optimising health and fitness before surgery. One of the major barriers in successfully implementing a prehabilitation program in hospitals has been poor patient adherence. In our pilot survey on surgical patients, we sought to explore patient preferences regarding the program design, the barriers and enablers to patient participation in a multimodal prehabilitation program. METHODS The survey was administered to patients undergoing major abdominal surgery in the preoperative period. The first two parts of the instrument mainly included questions on demographics, social history, activity levels, interest towards prehabilitation program and their involvement in co-design, preferences towards the components of the program, the barriers and enablers. The last part of survey included symptom and physical assessments. RESULTS The survey was completed by 24 patients undergoing major abdominal surgery. The median age of our cohort was 71 (range 35-91) years and 75% were retired. 75% of our participants were extremely interested in improving health and fitness and 63% were very keen to co-design their program when explained. Home-based programs were preferred by most participants and among exercises, walking was preferred by 71% of the participants. One third of the participants were interested in professional dietary counselling. There were only two participants who preferred group psychological therapy while 25% preferred individual psychological counselling sessions. CONCLUSION Our survey highlighted a need to design a personalised program with tailored interventions due to the wide variation in the interest and preferences among surgical patients.
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Abstract
PURPOSE OF REVIEW The purpose of this study is to evaluate the role of physical exercise and nutrition interventions in adult patients before elective major surgery. RECENT FINDINGS Exercise training before elective adult major surgery is feasible, safe, and efficacious, but the clinical effectiveness remains uncertain. Early data suggests a reduction in morbidity, length of stay, and quality of life, but the results of larger definitive studies are awaited. Nutritional interventions are less well evaluated and when they are, it is often in combination with exercise interventions as part of a prehabilitation package. SUMMARY Studies evaluating exercise and nutrition interventions before elective major surgery in adults are producing encouraging early results, but definitive clinical evidence is currently very limited. Future research should focus on refining interventions, exploring mechanism, and evaluating the interactions between therapies and large-scale clinical effectiveness studies.
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Affiliation(s)
- Malcolm A. West
- Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton NIHR Biomedical Research Centre, Southampton, UK
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul E. Wischmeyer
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC USA
- Duke Clinical Research Institute, Durham, NC USA
| | - Michael P. W. Grocott
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton NIHR Biomedical Research Centre, Southampton, UK
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Anaesthesia and Critical Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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