{{Short description|Medical term}}
'''Preoperative rehabilitation''', '''prehabilitation''' or '''prehab''', is a form of [[healthcare]] intervention that takes place before a [[therapy|medical]] or [[surgery|surgical]] intervention with the aim to reduce [[side effect]]s and [[Complication (medicine)|complications]], and enhance recovery.<ref name=":0" /><ref>{{Cite journal |last1=Wynter-Blyth |first1=Venetia |last2=Moorthy |first2=Krishna |date=2017-08-08 |title=Prehabilitation: preparing patients for surgery |url=https://www.bmj.com/content/358/bmj.j3702 |journal=BMJ |language=en |volume=358 |article-number=j3702 |doi=10.1136/bmj.j3702 |issn=0959-8138 |pmid=28790033|s2cid=29658090 |url-access=subscription }}</ref> Multidisciplinary team involvement can range from [[physiotherapist]]s, [[occupational therapist]]s, [[respiratory therapist]]s, [[physician|doctors]], [[pharmacologist]]s, [[anesthesiologist]]s, [[psychologist]]s, [[psychiatrist]]s and [[sports physiotherapy|sports physiologists]].<ref name=":0">{{Cite web |date=30 Nov 2020 |title=Principles and guidance for prehabilitation within the management and support of people with cancer |url=https://cdn.macmillan.org.uk/dfsmedia/1a6f23537f7f4519bb0cf14c45b2a629/1532-source/prehabilitation-for-people-with-cancer-tcm9-353994 |website=Macmillan Cancer Support}}</ref>
Prehab can be applied to surgical populations in [[oncology]], cardiorespiratory, cardiovascular and orthopaedic settings. The intention is that increasing baseline fitness prior to surgery will allow for relatively higher fitness post-operatively. Prehabilitation interventions are tailored to the patient so that even those with high amounts of [[comorbidity|comorbidities]] can receive a positive outcome. Research evidence is mixed, but suggests that prehabilitation reduces hospital stays and therefore risk of hospital acquired infections such as [[pneumonia]].<ref name=":0" />
Prehab is also being considered for use in some cardiovascular interventions,<ref>{{cite journal |vauthors=Alkarmi A, Thijssen DH, Albouaini K, etal |date=June 2010 |title=Arterial prehabilitation: can exercise induce changes in artery size and function that decrease complications of catheterization? |journal=Sports Medicine |volume=40 |issue=6 |pages=481–92 |doi=10.2165/11531950-000000000-00000 |pmid=20524713 |s2cid=24870534}}</ref> and may also be of some benefit for preventing lung complications, such as [[pulmonary atelectasis]], in general surgery.<ref>{{cite journal |vauthors=Jack S, West M, Grocott MP |date=September 2011 |title=Perioperative exercise training in elderly subjects |journal=Best Practice & Research. Clinical Anaesthesiology |volume=25 |issue=3 |pages=461–72 |doi=10.1016/j.bpa.2011.07.003 |pmid=21925410}}</ref>
For older people with [[Frailty syndrome|frailty]] undergoing [[abdominal surgery]], prehabilitation programmes that include exercise, improved diet and psychological support can reduce the [[Length of stay|length of hospital stay]] and decrease the risk of serious complications.<ref>{{Cite journal |last=Skořepa |first=Pavel |last2=Ford |first2=Katherine L. |last3=Alsuwaylihi |first3=Abdulaziz |last4=O'Connor |first4=Dominic |last5=Prado |first5=Carla M. |last6=Gomez |first6=Dhanny |last7=Lobo |first7=Dileep N. |date=2024-01-22 |title=The impact of prehabilitation on outcomes in frail and high-risk patients undergoing major abdominal surgery: A systematic review and meta-analysis |url=https://linkinghub.elsevier.com/retrieve/pii/S0261561424000153 |journal=Clinical Nutrition |language=en |volume=43 |issue=3 |pages=629–648 |doi=10.1016/j.clnu.2024.01.020}}</ref>
== Prehabilitation Evaluation == A physician can evaluate a patient based on a few metrics to determine their need for pehabilitation. The most important factor is the patient's ability to perform [[activities of daily living]], which can mean asking the patient about their ability to make their own food, make phone calls, perform household chores, and take their medications<ref name=":1">{{Cite journal |last=Kumar |first=Chandrika |last2=Salzman |first2=Brooke |last3=Colburn |first3=Jessica L. |date=2018-08-15 |title=Preoperative Assessment in Older Adults: A Comprehensive Approach |url=https://pubmed.ncbi.nlm.nih.gov/30215973 |journal=American Family Physician |volume=98 |issue=4 |pages=214–220 |issn=1532-0650 |pmid=30215973}}</ref>. Their specific needs help to determine the prehabilitation approach. The provider may then recommend exercise, advice on nutrition, or referral to another provide to help with managing pain or anxiety<ref name=":1" />.
== Research == A 2013 pilot study of prehabilitation in [[colorectal surgery]] found improved postoperative functional recovery, measured in terms of the walking capacity at 4 weeks and 8 weeks. However, the time in hospital and post-operative complications were similar.<ref>{{cite journal |vauthors=Li C, Carli F, Lee L, etal |title=Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study |journal=Surgical Endoscopy |volume=27 |issue=4 |pages=1072–82 | date=April 2013 |pmid=23052535 |doi=10.1007/s00464-012-2560-5|s2cid=9888085 |url=https://escholarship.mcgill.ca/concern/theses/rr1721660 |url-access=subscription }}</ref>
According to a 2020 study looking at men awaiting surgery for urological cancer, [[high-intensity interval training]] (HIIT) may improve [[Cardiorespiratory fitness|heart and lung fitness]] within a month before their surgery.<ref>{{Cite journal |date=2020-06-05 |title=High-intensity interval training rapidly improves fitness in patients awaiting surgery for urological cancer |url=https://evidence.nihr.ac.uk/alert/high-intensity-interval-training-rapidly-improves-fitness-in-patients-awaiting-surgery-for-urological-cancer/ |journal=NIHR Evidence |type=Plain English summary |language=en |publisher=National Institute for Health and Care Research |doi=10.3310/alert_40363|s2cid=242684291 |url-access=subscription }}</ref><ref>{{Cite journal |last1=Blackwell |first1=J. E. M. |last2=Doleman |first2=B. |last3=Boereboom |first3=C. L |last4=Morton |first4=A. |last5=Williams |first5=S. |last6=Atherton |first6=P. |last7=Smith |first7=K. |last8=Williams |first8=J. P. |last9=Phillips |first9=B. E. |last10=Lund |first10=J. N. |date=10 March 2020 |title=High-intensity interval training produces a significant improvement in fitness in less than 31 days before surgery for urological cancer: a randomised control trial |journal=Prostate Cancer and Prostatic Diseases |language=en |volume=23 |issue=4 |pages=696–704 |doi=10.1038/s41391-020-0219-1 |issn=1365-7852 |pmc=7655502 |pmid=32157250}}</ref>
According to recommendations from American Family Physicians, particularly in older adults, one of the greatest predictors of postoperative risk of death is related to falls<ref name=":02">{{Cite journal |last=Kumar |first=Chandrika |last2=Salzman |first2=Brooke |last3=Colburn |first3=Jessica L. |date=2018-08-15 |title=Preoperative Assessment in Older Adults: A Comprehensive Approach |url=https://pubmed.ncbi.nlm.nih.gov/30215973 |journal=American Family Physician |volume=98 |issue=4 |pages=214–220 |issn=1532-0650 |pmid=30215973}}</ref>. Those who have mobility limitations or who take medications associated with falls are at greatest risk. In those patients preparing to undergo surgery, if they participate in prehabilitation with physical therapy and exercise they are at lower risk of postoperative complications<ref name=":02" />.
==See also== * [[Rehabilitation (disambiguation)|Rehabilitation]]
==References== {{reflist}} [[Category:Rehabilitation medicine]] [[Category:Physical exercise]]
{{Sport-stub}} {{Physical therapy and rehabilitation|state=expanded}} [[Category:Surgery]] [[Category:Cancer treatments]]