Prehabilitation <i>versus</i> Rehabilitation

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  • Chelsia Gillis
    From the Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada (C.G., R.A., B.A.); and Department of Surgery (C.L., L.L., A.S.L., B.S., P.C., L.S.F.) and Department of Anesthesia (A.G., F.C.), McGill University, Montreal, Quebec, Canada.
  • Chao Li
    From the Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada (C.G., R.A., B.A.); and Department of Surgery (C.L., L.L., A.S.L., B.S., P.C., L.S.F.) and Department of Anesthesia (A.G., F.C.), McGill University, Montreal, Quebec, Canada.
  • Lawrence Lee
    From the Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada (C.G., R.A., B.A.); and Department of Surgery (C.L., L.L., A.S.L., B.S., P.C., L.S.F.) and Department of Anesthesia (A.G., F.C.), McGill University, Montreal, Quebec, Canada.
  • Rashami Awasthi
    From the Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada (C.G., R.A., B.A.); and Department of Surgery (C.L., L.L., A.S.L., B.S., P.C., L.S.F.) and Department of Anesthesia (A.G., F.C.), McGill University, Montreal, Quebec, Canada.
  • Berson Augustin
    From the Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada (C.G., R.A., B.A.); and Department of Surgery (C.L., L.L., A.S.L., B.S., P.C., L.S.F.) and Department of Anesthesia (A.G., F.C.), McGill University, Montreal, Quebec, Canada.
  • Ann Gamsa
    From the Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada (C.G., R.A., B.A.); and Department of Surgery (C.L., L.L., A.S.L., B.S., P.C., L.S.F.) and Department of Anesthesia (A.G., F.C.), McGill University, Montreal, Quebec, Canada.
  • A. Sender Liberman
    From the Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada (C.G., R.A., B.A.); and Department of Surgery (C.L., L.L., A.S.L., B.S., P.C., L.S.F.) and Department of Anesthesia (A.G., F.C.), McGill University, Montreal, Quebec, Canada.
  • Barry Stein
    From the Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada (C.G., R.A., B.A.); and Department of Surgery (C.L., L.L., A.S.L., B.S., P.C., L.S.F.) and Department of Anesthesia (A.G., F.C.), McGill University, Montreal, Quebec, Canada.
  • Patrick Charlebois
    From the Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada (C.G., R.A., B.A.); and Department of Surgery (C.L., L.L., A.S.L., B.S., P.C., L.S.F.) and Department of Anesthesia (A.G., F.C.), McGill University, Montreal, Quebec, Canada.
  • Liane S. Feldman
    From the Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada (C.G., R.A., B.A.); and Department of Surgery (C.L., L.L., A.S.L., B.S., P.C., L.S.F.) and Department of Anesthesia (A.G., F.C.), McGill University, Montreal, Quebec, Canada.
  • Francesco Carli
    From the Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada (C.G., R.A., B.A.); and Department of Surgery (C.L., L.L., A.S.L., B.S., P.C., L.S.F.) and Department of Anesthesia (A.G., F.C.), McGill University, Montreal, Quebec, Canada.

Description

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background:</jats:title> <jats:p>The preoperative period (prehabilitation) may represent a more appropriate time than the postoperative period to implement an intervention. The impact of prehabilitation on recovery of function al exercise capacity was thus studied in patients undergoing colorectal resection for cancer.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>A parallel-arm single-blind superiority randomized controlled trial was conducted. Seventy-seven patients were randomized to receive either prehabilitation (n = 38) or rehabilitation (n = 39). Both groups received a home-based intervention of moderate aerobic and resistance exercises, nutritional counseling with protein supplementation, and relaxation exercises initiated either 4 weeks before surgery (prehabilitation) or immediately after surgery (rehabilitation), and continued for 8 weeks after surgery. Patients were managed with an enhanced recovery pathway. Primary outcome was functional exercise capacity measured using the validated 6-min walk test.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Median duration of prehabilitation was 24.5 days. While awaiting surgery, functional walking capacity increased (≥20 m) in a higher proportion of the prehabilitation group compared with the rehabilitation group (53 vs. 15%, adjusted P = 0.006). Complication rates and duration of hospital stay were similar. The difference between baseline and 8-week 6-min walking test was significantly higher in the prehabilitation compared with the rehabilitation group (+23.7 m [SD, 54.8] vs. −21.8 m [SD, 80.7]; mean difference 45.4 m [95% CI, 13.9 to 77.0]). A higher proportion of the prehabilitation group were also recovered to or above baseline exercise capacity at 8 weeks compared with the rehabilitation group (84 vs. 62%, adjusted P = 0.049).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>Meaningful changes in postoperative functional exercise capacity can be achieved with a prehabilitation program.</jats:p> </jats:sec>

Journal

  • Anesthesiology

    Anesthesiology 121 (5), 937-947, 2014-11-01

    Ovid Technologies (Wolters Kluwer Health)

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