Physiotherapy - Theses
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ItemMultidisciplinary prehabilitation in clinical practice for haematologic patients receiving high dose chemotherapy with autologous stem cell transplant( 2023-04)Autologous stem cell transplant (AuSCT) is an intensive treatment for patients with haematologic cancer, with the potential for significant functional and psychological decline. Cancer prehabilitation is a package of care provided prior to major oncological treatment that aims to mitigate this decline. Currently the predominance of prehabilitation evidence is in efficacy trials in surgical cohorts. In these populations, findings for prehabilitation are broadly favourable. Despite this, the uptake of routine prehabilitation into clinical services remains low, especially in Australia. Hence, evidence evaluating implementation and effectiveness of prehabilitation in clinical practice is limited. Research examining prehabilitation in real-world settings is needed to inform further service development. The studies reported in this thesis aimed to (1) evaluate the impact of a new allied health prehabilitation service for haematologic patients receiving AuSCT in a tertiary cancer centre; and (2) identify health care professionals’ (HCPs) perceptions of enablers and barriers to two behaviours: referral for, and delivery of, multidisciplinary prehabilitation prior to AuSCT. Study one analysed 12 months of prospectively collected data. Impact and operational success were investigated using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Patients were representative of Australian AuSCT patients on key demographic variables and clinically relevant improvements in outcomes were demonstrated, however missing data were an issue. The service was well adopted by clinicians and fidelity of exercise prescription (Implementation) was moderate. The referral trend over time (Maintenance) was high after the initiation period. Study two was based on the Theoretical Domains Framework (TDF) of behaviour change. Fourteen HCPs at a tertiary cancer centre participated in semi-structured interviews based on the TDF. Novel findings included the predominance of reported enablers in comparison to barriers. Enablers included: the belief that patients will benefit from prehabilitation; and that face-to-face initial assessments and multidisciplinary teamwork are essential. These studies evaluated prehabilitation in clinical practice prior to AuSCT and provided original contributions to knowledge in this area. Evidence informed recommendations for prehabilitation service delivery are presented, that may support implementation of prehabilitation programs in hospital settings where uptake remains low. Findings may not be generalisable to all oncology populations and settings, in particular, organisations in which prehabilitation is not already included in hospital policy. There is scope for further research into prehabilitation implementation solutions, to inform best practice care and improve outcomes.
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ItemPrehabilitation for individuals having lung cancer surgery( 2020)Non-small cell lung cancer (NSCLC) is the fourth most commonly diagnosed cancer in males and the fourth most commonly diagnosed cancer in females in Australia. It is the leading cause of cancer-related mortality, being responsible for more deaths than breast, colorectal and prostate cancer combined. Pulmonary resection provides the best chance of a cure for patients with early stage lung cancer. However, pulmonary resection is associated with significant impairment in functional capacity along with a moderate risk of postoperative morbidity, particularly in frail or deconditioned patients. Prehabilitation is defined as “a process on the continuum of care that occurs between the time of cancer diagnosis and the beginning of acute treatment that, in the perioperative setting, aims to enhance functional capacity of the individuals to enable them to withstand the stress associated with a procedure”. Prehabilitation can include a care bundle incorporating smoking cessation, diet optimization, psychosocial support and exercise, and aims to identify impairments and deliver targeted interventions that improve patient outcomes. It provides an opportunity to decrease treatment-related morbidity, increase available treatment options for patients who would not otherwise be surgical candidates and facilitate return of patients to the highest possible functional level. There is a growing body of evidence that supports prehabilitation as a means of preparing patients with newly diagnosed cancer for surgery by optimizing their health preoperatively. Enhancing a patient’s preoperative condition may help them withstand the stressors of surgery. Evidence supports the implementation of prehabilitation in the preoperative care pathway of other cancer cohorts, for example colorectal, breast and prostate cancers. Unfortunately, the evidence for the effects of prehabilitation in lung cancer has lagged behind and the use of prehabilitation (specifically the exercise component) for patients with lung cancer is now an emerging area. To date, exercise prior to lung cancer surgery has been shown to be safe and associated with improvements in functional capacity as well as postoperative morbidity (hospital length of stay) and rates of postoperative pulmonary complications), however the feasibility and acceptability of prehabilitation for patients with lung cancer is still unclear. The two studies within this thesis focus on the exercise component of prehabilitation in the context of surgical management of lung cancer in Australia.