Best evidence summary on prehabilitation interventions of patients undergoing elective gastrointestinal surgery / 中华护理杂志

Objective To retrieve,evaluate and summarize the best evidence of prehabilitation interventions of patients undergoing elective gastrointestinal surgery,so as to provide references for clinical application.Methods All evidence on prehabilitation interventions of patients undergoing elective gastrointestinal surgery was retrieved from databases and websites including UpToDate,JBI Library,PubMed,CINAHL,Cochrane Library,CNKI,CBM,Wanfang and NGC,SIGN,NICE,NZGG,RNAO,ONS,ESPEN,CGC,CACA,CAMCSPEN.The retrieved evidence inclu-ded guidelines,clinical decisions,expert consensuses,evidence summaries,systematic reviews,randomized controlled trials,et al.The retrieval time limit was from the database construction to March,2022.Results Totally 21 articles were involved,including 6 guidelines,8 expert consensuses,2 meta-analyses and 5 systematic reviews.The overall quality of the included literature was high.Finally,22 pieces of best evidence about nutritional support,exercise training and psychological intervention were summarized.Conclusion The best evidence for prehabilitation intervention of patients undergoing elective gastrointestinal surgery summarized in this study is scientific and practical to a certain extent,which can provide bases for clinical workers to carry out prehabilitation clinical practice.

Feasibility of a Home-based Exercise Program after Abdominally Based Autologous Breast Surgery Reconstruction：An Observational Study / The Japanese Journal of Rehabilitation Medicine

Objective：We aimed to evaluate the feasibility of our rehabilitation program for abdominally based rehabilitation following autologous breast reconstruction, and investigate the changes in physical function and health-related quality of life in the early postoperative period.Methods：Fifteen patients who underwent breast reconstruction between September 2020 and October 2021 were included in this prospective, observational case series.The program composed of prehabilitation and postoperative home-based exercise until 12 weeks post-surgery. Adherence to home exercise program was surveyed using a self-reported workout check list. At postoperative 4th, 8th, 12th, and 24th weeks, a physio-/occupational therapist assessed the following objectives：i) Range of motion, muscle strength, and disability of upper extremity and trunk, ii) Quality of life using EQ-5D questionnaire, and iii) Patients' daily activities.Results：No adverse events were observed, and all patients completed the program. Overall adherence to daily exercise was 71.1％．Physical function of the upper extremities recovered in 8th postoperative week；however, truncal function, quality of life, and daily activities in 12th postoperative week remained lower than those observed preoperatively. Nevertheless, the program appeared useful for many patients, although some reported difficulty in continuing the exercise after returning to work.Conclusion：Rehabilitation programs directed by physio/occupational therapists may play a potentially advantageous role in facilitating a return to baseline function and quality of life during the early postoperative period.

Feasibility of a Home-based Exercise Program after Abdominally Based Autologous Breast Surgery Reconstruction：An Observational Study / The Japanese Journal of Rehabilitation Medicine

Objective：We aimed to evaluate the feasibility of our rehabilitation program for abdominally based rehabilitation following autologous breast reconstruction, and investigate the changes in physical function and health-related quality of life in the early postoperative period.Methods：Fifteen patients who underwent breast reconstruction between September 2020 and October 2021 were included in this prospective, observational case series.The program composed of prehabilitation and postoperative home-based exercise until 12 weeks post-surgery. Adherence to home exercise program was surveyed using a self-reported workout check list. At postoperative 4th, 8th, 12th, and 24th weeks, a physio-/occupational therapist assessed the following objectives：i) Range of motion, muscle strength, and disability of upper extremity and trunk, ii) Quality of life using EQ-5D questionnaire, and iii) Patients' daily activities.Results：No adverse events were observed, and all patients completed the program. Overall adherence to daily exercise was 71.1％．Physical function of the upper extremities recovered in 8th postoperative week；however, truncal function, quality of life, and daily activities in 12th postoperative week remained lower than those observed preoperatively. Nevertheless, the program appeared useful for many patients, although some reported difficulty in continuing the exercise after returning to work.Conclusion：Rehabilitation programs directed by physio/occupational therapists may play a potentially advantageous role in facilitating a return to baseline function and quality of life during the early postoperative period.

Application value of short-term prehabilitation in elderly patients undergoing gastrointestinal tumor surgery / 中国实用护理杂志

Objective:To explore the effectiveness of short-term prehabilitation in elderly patients undergoing gastrointestinal tumor surgery.Methods:Elderly patients(139 cases) with gastrointestinal tumors who were admitted to Nanfang Hospital, Southern Medical University for surgery from December 2020 to January 2022 were included through the purposive sampling method, and were divided into the intervention group (69 cases) and the control group (70 cases) according to the patient's wishes using a quasi-experimental research design of non randomized grouped. Routine perioperative nursing was used in the control group, while the short-term prehabilitation was used in the intervention group in addition. The incidence of postoperative complications, the performance indicators, and postoperative functional recovery indicators were analyzed in the two groups.Results:The 6MWD in the intervention group of 1 day and 7 days after the surgery were (460.93 ± 76.36) m and (391.72 ± 72.93) m, which were significant higher than those in the control group, (423.69 ± 72.88) m and (351.13 ± 65.04) m ( t = 8.65, 12.01, both P<0.05). The first exhaust time, first postoperative ambulatory time, the first full fluid intake time and the duration of drainage tube indwelling in the intervention group were (51.28 ± 21.74) h, (33.93 ± 12.50) h, (69.39 ± 29.36) h and (4.30 ± 1.44) d, which were significant lower than those in the control group, (71.51 ± 23.68) h, (47.37 ± 14.58) h, (96.29 ± 38.36) h and (5.35 ± 2.09) d ( t values were -5.83 - -3.44, all P<0.05). Besides, the best critical value of preoperative 6MWD to predict postoperative rehabilitation effect was 477.5 m, with a sensitivity of 68% and specificity of 71%. Conclusions:Short-term prehabilitation improves the perioperative functional reserve and promotes overall functional recovery after surgery to a certain extent, and the postoperative functional recovery effect may be better when the patient′s preoperative 6MWD reaches 477.5 m.

Resultados funcionales de un programa de prehabilitación en cirugía electiva de cáncer colorrectal / Functional results of a prehabilitation program in elective colorectal cancer surgery

Resumen Introducción: El cáncer colorrectal (CCR) es el segundo tipo más frecuente de cáncer en el mundo. La cirugía es la intervención terapéutica más común y se asocia con la reducción de 20-40% en la capacidad fisiológica y funcional. Un programa de prehabilitación podría mejorar la condición funcional basal de los pacientes previo a la cirugía. Objetivo: Describir los resultados funcionales de un programa de prehabilitación en personas adultas candidatos a cirugía electiva de CCR. Materiales y Método: Estudio descriptivo, longitudinal y retrospectivo. Se registraron los antecedentes sociodemográficos, clínicos y las variables funcionales como capacidad cardiorrespiratoria, fuerza de presión manual, fatiga, independencia en actividades de la vida diaria (AVDs) y equilibrio dinámico de 50 personas que ingresaron a un programa de prehabilitación entre mayo 2019 y febrero de 2020. Los datos fueron analizados con estadística descriptiva y pruebas de diferencia entre tiempo de evaluación, previo y posterior a la prehabilitación. Resultados: Posterior al programa de prehabilitación, los pacientes mejoraron la capacidad cardiorrespiratoria, fatiga, equilibrio dinámico y fuerza prensil (p 0,05; tamaño de efecto: 0,01). Conclusión: Un programa estructurado de prehabilitación para pacientes candidatos a cirugía electiva de CCR basado en ejercicios y educación, logró cambios significativos en los resultados funcionales en un período de 3 a 4 semanas previo a la cirugía.

Introduction: Colorectal cancer (CRC) is the second most frequent type of cancer in the world. Surgery is the most common therapeutic intervention and is associated with a 20-40% reduction in physiological and functional capacity. A prehabilitation program could improve the baseline functional condition of patients prior to surgery. Aim: To describe the functional results of a prehabilitation program in adults who will undergo elective surgery CCR. Materials and Method: Descriptive, longitudinal and retrospective study. The sociodemographic, clinical and functional variables such as cardiorespiratory capacity, manual pressure force, fatigue, independence in activities of daily living and dynamic balance of 50 people who entered a pre-rehabilitation program between may 2019 and february 2020 were compiled. Data were analyzed with descriptive statistics and difference tests between evaluation time, before and after prehabilitation. Results: After the prehabilitation program, the patients improved cardiorespiratory capacity, fatigue, dynamic balance and grip strength (p 0.05; effect size: 0.01). Conclusión: A structured prehabilitation program for patients who are candidates for elective colorectal cancer surgery based on exercises and education, achieved significant changes in functional results in a period of 3 to 4 weeks prior to surgery.

Prehabilitation for gastrointestinal cancer patients / 中华胃肠外科杂志

Gastrointestinal cancer and related treatments (surgery and chemoradiotherapy) are associated with declined functional status (FS) that has impact on quality of life, clinical outcome and continuum of care. Psychological distress drives an impressive burden of physiological and psychiatric conditions in oncologic care. Cancer patients often experience anxiety, depression, low self-esteem and fears of recurrence and death. Cancer prehabilitation is a process from cancer diagnosis to the beginning of treatment, which includes psychological, physical and nutritional assessments for a baseline functional level, identification of comorbidity, and targeted interventions that improve patient's health and functional capacity to reduce the incidence and the severity of current and future impairments with cancer, chemoradiotherapy and surgery. Multimodal prehabilitation program encompasses a series of planned, structured, repeatable and purposive interventions including comprehensive physical exercise, nutritional therapy, and relieving anxiety and depression, which integrates into best perioperative management ERAS pathway and aims at using the preoperative period to prevent or attenuate the surgery-related functional decline, to cope with surgical stress and to improve the consequences. However, a number of questions remain in regards to prehabilitation in gastrointestinal cancer surgery, which consists of the optimal makeup of training programs, the timing and approach of the intervention, how to improve compliance, how to measure functional capacity, and how to make cost-effective analysis. Therefore, more high-level evidence-based studies are expected to evaluate the value of implementation of prehabilitation into standard practice.

Influence of perioperative pulmonary rehabilitation system based on prehabilitation on early weaning during cardiac perioperative period / 中华胸心血管外科杂志

Objective:To evaluate the clinical effect of the pulmonary rehabilitation system based on the concept of prehabilitation for patients after cardiac surgery to wean tube and avoid related complications.Methods:From January 2018 to December 2019 in a single-center(third-class hospital in cardiac surgery intensive care unit), all adult patients hospitalized for 7 days before open-heart surgery were included. They were randomly divided into pulmonary rehabilitation group(198 cases) and control group(234 cases). To compare and analyze the clinical effects, the main observations were observed including overall outcome indicators(such as early extubation rate, ICU stay, hospitalization costs, advanced oxygen therapy support after extubation) and lung outcome related indicators(such as the occurrence of pulmonary complications, chest drainage, secondary intubation, tracheotomy, lung infection and chest tube drainage).Results:There was no statistical difference between groups in basic conditions and surgical conditions. The lung rehabilitation group significantly increased the rate of early extubation, reduced the number of advanced oxygen therapy after weaning, shortened the length of ICU stay, saved hospitalization cost, significantly reduced the occurrence of postoperative respiratory complications and improved postoperative respiratory function( P<0.05). Conclusion:During cardiac perioperation, pulmonary rehabilitation significantly can increase the rate of early extubation , shorten the length of mechanical ventilation, reduce the occurrence of secondary tracheal intubation and pulmonary complications. And it can also effectively promote the recovery of lung function and the overall recovery.

Study protocol of a single-arm pre-post study to assess the preliminary effectiveness and feasibility of a home-based bimodal prehabilitation program on preoperative aerobic fitness in high-risk patients scheduled for liver or pancreatic resection

Background:Controversial evidence currently exists regarding the feasibility and effectiveness to improve preoperative aerobic fitness during home-based prehabilitation in patients scheduled for liver or pancreatic resection, whereas morbidity rates are high following these resections. The primary aim of this study is to evaluate the preoperative oxygen uptake (VO2) at the ventilatory anaerobic threshold before and after a four-week home-based preoperative training program with nutritional supplementation in high-riskpatients scheduled for elective liver or pancreatic resection. Secondary aims are to evaluate program feasibility, immune system function, cardiopulmonary exercise test responses, individual progression profiles on training responses, quality of life, andpostoperative course.Methods:In this multicenter study with a pretest-posttest design, patients with a liver or pancreatic tumor scheduled for elective resection will be recruited. To select the high-risk fraction of this surgical population, their VO2at the ventilatory anaerobic threshold should be <11 ml/kg/min for final inclusion. A planned total of 24 high-risk patients will participate in a four-week (three sessions per week) home-based bimodal prehabilitation program. The partly supervised home-based preoperative training program consists of individualized goal setting followed by titration of interval and endurance training on an advanced cycle ergometer, combined with functional task exercises. Additionally, patients will be given protein and vitamin/mineral supplementation.Discussion: Effects of a partly supervised home-based bimodal prehabilitation regimen are unknown in high-risk patients opting for liver or pancreatic resection. Improved preoperative aerobic fitness might translate into improved postoperative outcomes and a reduced demand on care resources.Trial Registration:The study is registered in the Netherlands Trial Registry (NL6151) and was approved by the Institutional Ethics Committee, Twente, Enschede, the Netherlands (P17-08)

Application of pre-hospital prerehabilitation strategy based on enhanced recovery after surgery (ERAS) concept in patients with pulmonary tumor / 中国实用护理杂志

Objective To explore the practical effect of pre-hospital prehabilitation strategy in pulmonary tumor patients. Methods A total of 68 patients receiving thoracic surgery in Department of Pulmonary Oncology, Tianjin Medical University Cancer Institute & Hospital, during July 2018 to April 2019, were divided into pre-hospital prehabilitation group (n=34) and control group (n=34), according to the order of outpatient. Patients in control group received routine guidance before thoracic surgery, and those in pre- hospital prehabilitation group received a home- based preoperative intervention. The differences of 6-minute walking distance (6MWD), hospital anxiety and depression score (HADS), forced expiratory volume at the first second (FEV1), forced vital capacity (FVC), postoperative thoracic drainage and complications were compared between the two groups. Results The values of 6MWD, FEV1 and FVC in the pre-hospital prehabilitation group were (611.08±47.13) m, (2.48±0.51) L and (3.43±0.48) L on one day preoperatively, respectively, while in the control group, the values were (520.26±57.33) m, (2.19± 0.38) L and (3.17±0.58) L, respectively, with statistically significant differences, t=7.136, 2.659, 2.014, P<0.05. The values of 6MWD, FEV1 and FVC in the pre-hospital prehabilitation group were (540.27±85.73) m, (2.07±0.46) L and (2.98±0.67) L at 30 days postoperatively, respectively, while in the control group, the values were (488.86±75.04) m, (1.82±0.51) L and (2.42±0.58) L, respectively, with statistically significant differences, t=2.631, 2.122, 3.685, P<0.05. The thoracic drainage of pre-hospital prehabilitation group and control group were (162.35 ± 43.08) ml and (191.42 ± 69.11) ml, respectively, t=2.081, P<0.05. In addition, the occurrence rates of complications such as pulmonary infection, pulmonary atelectasis and arrhythmia were 0.0%(0/34), 2.9%(1/34), 0.0%(0/34) in the pre-hospital prehabilitation group, while those were 2.9%(1/34), 8.8%(3/34), 14.7%(5/34) in the control group, pre-hospital prehabilitation group had a significant reduction in the occurrence of arrhythmia (P<0.05). Conclusions The pre- hospital prehabilitation strategy significantly improve the perioperative functional status and prognosis of lung cancer patients, and reduce the occurrence of postoperative complications to a certain extent, which is worth of being further promoted clinically.

Application of pre-hospital prerehabilitation strategy based on enhanced recovery after surgery (ERAS) concept in patients with pulmonary tumor / 中国实用护理杂志

Objective@#To explore the practical effect of pre-hospital prehabilitation strategy in pulmonary tumor patients.@*Methods@#A total of 68 patients receiving thoracic surgery in Department of Pulmonary Oncology, Tianjin Medical University Cancer Institute & Hospital, during July 2018 to April 2019, were divided into pre-hospital prehabilitation group (n=34) and control group (n=34), according to the order of outpatient. Patients in control group received routine guidance before thoracic surgery, and those in pre-hospital prehabilitation group received a home-based preoperative intervention. The differences of 6-minute walking distance (6MWD), hospital anxiety and depression score (HADS), forced expiratory volume at the first second (FEV1), forced vital capacity (FVC), postoperative thoracic drainage and complications were compared between the two groups.@*Results@#The values of 6MWD, FEV1 and FVC in the pre-hospital prehabilitation group were (611.08±47.13) m, (2.48±0.51) L and (3.43±0.48) L on one day preoperatively, respectively, while in the control group, the values were (520.26±57.33) m, (2.19±0.38) L and (3.17±0.58) L, respectively, with statistically significant differences, t=7.136, 2.659, 2.014, P<0.05. The values of 6MWD, FEV1 and FVC in the pre-hospital prehabilitation group were (540.27±85.73) m, (2.07±0.46) L and (2.98±0.67) L at 30 days postoperatively, respectively, while in the control group, the values were (488.86±75.04) m, (1.82±0.51) L and (2.42±0.58) L, respectively, with statistically significant differences, t=2.631, 2.122, 3.685, P<0.05. The thoracic drainage of pre-hospital prehabilitation group and control group were (162.35±43.08) ml and (191.42±69.11) ml, respectively, t=2.081, P<0.05. In addition, the occurrence rates of complications such as pulmonary infection, pulmonary atelectasis and arrhythmia were 0.0%(0/34), 2.9%(1/34), 0.0%(0/34) in the pre-hospital prehabilitation group, while those were 2.9%(1/34), 8.8%(3/34), 14.7%(5/34) in the control group, pre-hospital prehabilitation group had a significant reduction in the occurrence of arrhythmia (P<0.05).@*Conclusions@#The pre-hospital prehabilitation strategy significantly improve the perioperative functional status and prognosis of lung cancer patients, and reduce the occurrence of postoperative complications to a certain extent, which is worth of being further promoted clinically.

Advance in the perioperative management:Enhanced recovery after surgery,perioperative surgical home and perioperative medicine / 中国实用外科杂志

Surgery plays a pivotal role in the treatment of certain diseases,which in turn promotes the development of enhanced recovery after surgery (ERAS). However,with the renewal of concept and technology,it is gradually realized that the key to a successful treatment is not only surgery itself but also preoperative and postoperative management. Patientbased perioperative management is closely related to the prognosis of the disease. Therefore,“perioperative medicine”and“perioperative surgical home (PSH)”are gaining more and more attention from all over the world. These novel concepts aim to cover the whole disease treatment process and improve the prognosis.

The effect of preoperative prehabilitation on nutritional status and body composition of patients with esophageal cancer after operation / 肠外与肠内营养

Objective: To observe the efficacy of preoperative prehabilitation on nutritional status and body composition of patients with esophageal cancer after operation. Methods: A total of 100 patients with esophageal cancer were randomly divided into the study group A and the control group B. The study group received prehabilitation from the day they adimitted to hospital and the control group received common preoperative preparation. The preoperative baseline data and postoperative indicators including levels of serum albumin, prealbumin, transferrin were recorded the day admitted to hospital and the 1, 3, 7, 30th day after surgery. Record the prognosis of the patients (albumin supplementation, incidence of postoperative complications, ICU monitoring time, total cost of hospitalization). And the body composition was examined on the day admitted to hospital and the 7, 30th day after surgery with BIA. Results: The level of serum albumin, prealbumin, transferrin and body composition were no statistically significant difference between the study group and the control group. Compared with the control group, the level of prealbumin were significantly higher in the study group on the 1, 3, 7, 30th day after surgery. The level of serum albumin, transferrin were also significantly higher in study group on the 3, 7, 30th day after surgery. The body composition was no significant difference between the two groups on the 7th day postoperatively. However, the loss of body composition such as skeletal muscle, body water, intracellular water, protein level and body cell volume were less in the study group compared with the control group on the 30th day after surgery. The incidence of postoperative complications in the prehabilitation group, ICU monitoring time, and hospitalization costs were significantly less than those in the control group. Conclusion: Prehabilitation intervention can obviously improve the nutritional status and the prognosis of the patients with esophageal cancer, and reduce the loss degree of their body composition.

Preoperative physiotherapy and short-term functional outcomes of primary total knee arthroplasty

<p><b>INTRODUCTION</b>Physiotherapy is an important part of rehabilitation following arthroplasty, but the impact of preoperative physiotherapy on functional outcomes is still being studied. This randomised controlled trial evaluated the effect of preoperative physiotherapy on the short-term functional outcomes of primary total knee arthroplasty (TKA).</p><p><b>METHODS</b>50 patients with primary knee osteoarthritis who underwent unilateral primary TKA were randomised into two groups: the physiotherapy group (n = 24), whose patients performed physical exercises for six weeks immediately prior to surgery, and the nonphysiotherapy group (n = 26). All patients went through a similar physiotherapy regime in the postoperative rehabilitation period. Functional outcome assessment using the algofunctional Knee Injury and Osteoarthritis Outcome Score (KOOS) scale and range of motion (ROM) evaluation was performed preoperatively, and postoperatively at six weeks and three months.</p><p><b>RESULTS</b>Both groups showed a significant difference in all algofunctional KOOS subscales (p < 0.001). The mean score difference at six weeks and three months was not significant in the sports and recreational activities subscale for both groups (p > 0.05). Significant differences were observed in the time-versus-treatment analysis between groups for the symptoms (p = 0.003) and activities of daily living (p = 0.025) subscales. No significant difference in ROM was found when comparing preoperative measurements and those at three months following surgery, as well as in time-versus-treatment analysis (p = 0.928).</p><p><b>CONCLUSION</b>Six-week preoperative physiotherapy showed no significant impact on short-term functional outcomes (KOOS subscales) and ROM of the knee following primary TKA.</p>

Effects of Individual Prehabilitation on Functional Outcome Six Weeks after Total Knee Arthroplasty / 中国康复理论与实践

Objective To observe the effects of individual prehabilitation on the functional outcome six weeks after total knee arthroplas-ty (TKA). Methods The patients undergoing TKA from March, 2013 to August, 2015 were randomly divided into prehabilitation group (n=30) and control group (n=29). The prehabilitation group received individual rehabilitation since enrolled in the study. The control group re-ceived no prehabilitation. All the patients received regular pre-surgical education, surgery and post-surgical rehabilitation. Both groups were evaluated with Numerical Rating Scale (NRS) of pain, active range of motion (AROM), Manual Muscle Test (MMT), fall index, TimedUp and Go(TUG), and Hospital for Special Surgery-Knee Scale (HSS-KS). Results The scores of NRS reduced six weeks after TKA (t>2.342, P2.827, P0.05), and it increased in the control group six weeks after TKA (t>3.555, P0.05);the AROM of knee extension increased before TKA in the control group (Z=-2.257, P=0.024), and no increasement was found in the prehabilitation group (Z=0, P=1.000), and it decreased six weeks after TKA in both groups (Z>2.247, P2.387, P0.05). The muscle strength of trunk extensor and the upside of rectus abdominis showed no statistical difference between two groups six weeks after TKA (t0.05), the muscle strength of the downside of rectus abdominis and external oblique was more in the prehabilitation group than in the control group (t=2.585, P=0.013). There was no significant difference in the fall index be-fore TKA (t0.05), and it was lower in the prehabilitation group than in the control group six weeks after TKA (t=-2.837, P=0.007). The time of TUG shortened before TKA in the prehabilitation group (t=3.554, P=0.002), and it prolonged in the control group (t=-4.507, P2.092, P<0.05). Conclusion Individual prehabilitation could reduce pain, and improve the trunk muscles, the ability of walking and the function of the knee before and six weeks after TKA.