EVOLUTIONARY STEPS IN THE IMPLEMENTATION OF A PREHABILITATION SERVICE: FROM KNOWLEDGE GENERATION TO CLINICAL PRACTICE
DOI:
https://doi.org/10.34635/rpc.935Abstract
The surgical population is becoming increasingly older, with complex medical needs (including deconditioning from sedentary lifestyles)1. This phenomenon represents a challenge for the perioperative team, because it leads to a significant increase in surgery-related morbidity and mortality rates. Poor physical condition and functional status reduces the ability to cope, mentally and physically, with hospitalization and surgery and may compromise postoperative functional recovery, potentially leading to postoperative complications and death2.
Multimodal prehabilitation has emerged in recent years as an innovative intervention that focuses on optimizing physiological and psychological resilience to withstand the upcoming stress of surgery. It involves a comprehensive, preventive, short-term, patient-centred programme lasting around four weeks designed to improve the patient’s aerobic capacity, nutritional balance, and psychological status, and to optimize existing multimorbidities3,4. Its ultimate aim is to enhance the patient’s functional capacity in order to minimize postoperative morbidity and accelerate recovery.
Several studies assessing prehabilitation have shown it to be an effective and highly advantageous strategy to prevent postoperative complications and reduce hospital length of stay in different populations5-8. However, despite the expected benefit, emerging recommendations from experts, and its cost-saving potential, the implementation of prehabilitation programmes in clinical practice is a major unmet need and an ongoing challenge for most hospitals. A comprehensive assessment of the implementation process is critical to identify the factors that can ensure success, and to generate recommendations for service transferability.
In this paper, we report our experience in imple- menting a multimodal prehabilitation programme as a mainstream service at the Hospital Clínic de Barcelona (HCB). The project started with a randomised clinical trial (RCT) carried out between 2013 and 2016, which showed the efficacy and cost-saving potential of prehabilitation. This was followed by the present multimodal programme, which has been adapted over time in accordance with the available resources and the feedback received from clinicians and patients. Over the years, we have identified the factors needed to scale-up the prehabilitation service. For successful, large scale implementation of a prehabilitation service more evidence of the effectiveness of such a programme in real-world scenarios is needed, the service needs to be standardised and modularised, and digital platforms and portable devices are required to improve patient access and empower self-management.
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