Jenna George

4/3/2019
Evidence Based Practice: Prehabilitation

Topic: Prehabilitation

Supporting Articles:

Boujibar, F., Bonnevie, T., Debeaumont, D., Bubenheim, M., Cuvellier, A., Peillon, C., … Baste,
J.-M. (2018). Impact of prehabilitation on morbidity and mortality after pulmonary lobectomy by
minimally invasive surgery: a cohort study. Journal of Thoracic Disease, 10(4), 2240–2248.
https://doi.org/10.21037/jtd.2018.03.161

Clode, N. J., Perry, M. A., & Wulff, L. (2018). Does physiotherapy prehabilitation improve pre-
surgical outcomes and influence patient expectations prior to knee and hip joint arthroplasty?
International Journal of Orthopaedic & Trauma Nursing, 30, 14–19. https://doi.org/10.1016/
j.ijotn.2018.05.004

McAdams-DeMarco, M. A., Ying, H., Van Pilsum Rasmussen, S., Schrack, J., Haugen, C. E.,
Chu, N. M., … Segev, D. L. (2019). Prehabilitation prior to kidney transplantation: Results from
a pilot study. Clinical Transplantation, (1). https://doi.org/10.1111/ctr.13450

Article Summary:

Boujibar et. al. found that prehabilitation methods used in thoracic surgery for non-small cell
lung cancer (NSCLC) were effective at reducing post operative complications. The group that
received pre-operational prehabilitation had a post operative complication rate of 40% versus the
other group that had a postoperative complication rate of 80%. It was concluded that in
minimally invasive surgery such as pulmonary lobectomy that prehabilitation was effective in
lowering both the occurrences and severity of surgery complications.

McAdams et. al. explored the results that rehabilitation could have on kidney patients waiting for
a transplant. Patients who wait for kidney transplants commonly experience decreased function
and while they wait for years surviving on dialysis. Prehabilitation in this study consisted of
weekly treatments by a physical therapist and a home exercise program. Most participants had
lower-extremity impairment, and were frail. At the two month mark, it was found that patients
who received prehabilitation improved their physical activity by 64% (P = 0.004). Patients
experienced shorter post-operative stays and increased function after their transplants.

Clode et. al. found that prehabilitation was especially effective in the outcomes of total knee
replacements and total hip replacements. An 8 week physiotherapy-led exercise and education
program attended bi-weekly resulted in substantially better outcomes in post operative recovery.
Assessments included WOMAC, NRS, Health Thermometer, 5xSTS and TUG outcome
measures. Re-assessments done 6 weeks after surgery showed that the prehabilitation group had
higher functioning levels and greater assessment scores than those not in the prehab group.
Patients who had received prehabilitation noted less pain and greater overall function post
operatively.

Outcome/Goal of EPB Research:

The research on a prehabilitative approach towards surgery to increase level of function and
education is showing itself to be effective in recovery time, higher levels of mobility, and
decreased surgery complications. Prehabilitation through means of exercise and surgery-specific
interventions could lead to faster rehabilitation times, less costs from complications, and better
outcomes for patients. Clinics should look at being the first line of referral in the pre-surgical
process to prepare patients for post operative outcomes and return to function. Working closely
with practitioners and surgeons to promote prehabilitation programs, and generating a referral
program within the community will increase the ability of physical therapists to widen the arena
of a patient’s post operative functioning.