Physiotherapy - Theses
Permanent URI for this collection
Search Results
1 - 1 of 1
-
ItemPrehabilitation in major cancer surgery: A focus on feasibility and barriers( 2021)Abdominal cancer surgery is the most common major surgical procedure performed in developed countries, however post-operative morbidity are high. Post-operative complications are common and associated with an increased morbidity and prolonged hospital stay whilst also contributing significant costs to the healthcare system. Prehabilitation aims to deliver interventions in the preoperative period to minimise the development of these complications and hasten recovery. The current evidence for prehabilitation for improving preoperative status is favourable, however its carry over into improvements in post-operative outcomes remain controversial and feasibility amongst high-risk patients in the real world setting unclear. An investigation into the feasibility of prehabilitation for the high-risk abdominal surgery population is needed. The studies within this thesis aimed to (1) identify, evaluate and synthesis the evidence examining the effect of prehabilitation with exercise on postoperative outcomes following abdominal cancer surgery (2) explore the acceptability of prehabilitation from the perspective of patients (3) investigate the feasibility of delivering a prehabilitation intervention to high-risk patients and (4) evaluate the current and likely future impact of a telehealth preoperative education package for patients preparing for major abdominal cancer surgery. Study 1 critically examined the literature, through a systematic review and meta-analysis, and found that multimodal prehabilitation programs were superior to unimodal programs at improving functional capacity prior to major abdominal cancer surgery as well as reducing hospital length of stay. However there was no difference in the number of postoperative complications, hospital re-admissions or postoperative mortality. Heterogeneity in the literature and a lack of consistency amongst outcome measures limited the ability to measure the effect of prehabilitation on post-operative complications. Study 2 explored the acceptability of prehabilitation from the patient perspective. Adult patients prior to major abdominal surgery were surveyed prior to the commencement of any prehabilitation program prior to major abdominal surgery. The results indicated that prehabilitation was a largely unknown concept for patients preparing for major cancer surgery. The survey found that although 82% of patients had not previously heard of prehabilitation, the majority of patients (71%) expressed interest in participating. Based on participants responses, several key recommendations for researchers, clinicians and policy makers designing prehabilitation programs in the future were developed. Results indicated that programs should be sensitive to the individual’s financial situation, recommended by treating health professionals (preferably doctors), delivered in convenient locations (preferably home) and telehealth interventions should be carefully chosen with the patient. Study 3 investigated the feasibility of a prehabilitation program, designed and conducted using the principles for high-risk patients awaiting major abdominal cancer surgery gained from Study 2. The findings showed trends to improvements in preoperative cardiorespiratory fitness. More research is needed to improve exercise fidelity reporting and adherence to exercise interventions within this complex group. Study 4 was conducted based on the findings of Study 3 to further explore the feasibility of providing a prehabilitation intervention to high-risk patients awaiting major abdominal surgery using a telehealth intervention developed to overcome distances required to travel to the hospital. Participants were delivered an online webinar consisting of six modules of prehabilitation information including the evidence behind prehabilitation, respiratory care bundle including breathing exercises and advice on oral hygiene, exercise prehabilitation, nutrition before surgery, psychological preparedness before surgery as well as pain management after surgery. Findings demonstrated that the webinar was well received, was memorable and had a positive effect on behaviour change within the two weeks after the session. Implementation within this study was examined using the RE-AIM framework and seven recommendations are provided for researchers, clinicians and/or policy makers to assist with implementation of similar programs in the future. These studies analysed the evidence for prehabilitation in the management of patients prior to major abdominal cancer surgery. Prehabilitation within this group was proposed to be feasible within the real-world setting. The evidence provided in this thesis consists of several recommendations regarding feasibility within this high-risk group that should be considered when designing and implementing prehabilitation interventions as well as for future research studies. They present an original contribution to knowledge in this area. These findings may not be generalisable to all settings and may require further research in different surgical populations, settings and healthcare systems. The literature base for prehabilitation needs to grow to fully determine its effectiveness and implementation strategies designed with patient input to maximise their impact.