Abstract
Objective
Methods
Results
ACKNOWLEDGMENTS
REFERENCES
Fig. 1.
![arm-22126f1.tif](/upload/SynapseXML/1041arm/thumb/arm-22126f1.gif)
Fig. 2.
![arm-22126f2.tif](/upload/SynapseXML/1041arm/thumb/arm-22126f2.gif)
Table 1.
Outcome measure | Collection time points | |
---|---|---|
Functional (physical) | Baseline | |
6-minute walk test (primary) | Pre-op (post-prehab) | |
30-Second Sit to Stand test | 3-month follow-up | |
Timed Up and Go test | ||
Psychological | Baseline | |
Hospital Anxiety and Depression Scale score | Pre-op (post-prehab) | |
3-month follow-up | ||
Quality of life (health-related) | Baseline | |
EuroQol-5 dimension | 3-month follow-up | |
Others | ||
Acute post-op hospital length-of-stay | During admission for surgery | |
Post-op major complications rates (30 day) | During admission for surgery up to 30 days post-op | |
Readmission rates (30 day & 3 mo) | Up to 3 months post-op | |
Mortality (30 day & 3 mo) | Up to 3 months post-op | |
Patient satisfaction survey to Prehab Program (see Appendix 3) | Pre-op (post-prehab) | |
3-month follow-up |
Table 2.
Baseline characteristic | Value |
---|---|
Total screened | 211 (100) |
Total enrolled | 182 (86.3) |
Cancer types | |
Colorectal | 120 (65.9) |
Hepato-pancreato-biliary | 45 (24.7) |
Urological | 13 (7.1) |
Upper gastrointestinal | 4 (2.2) |
Age (yr) | 70.43±10.64 |
Sex, male | 108 (59.3) |
Race | |
Chinese | 143 (78.6) |
Malay | 25 (13.7) |
Indian | 9 (4.9) |
Others | 5 (2.8) |
Frailty score | |
Frail | 92 (50.5) |
Pre-frail | 48 (26.4) |
Non-frail | 42 (23.1) |
Smoking | |
Non-smokers | 147 (80.8) |
Current smokers | 15 (8.2) |
Ex-smokers | 20 (11.0) |
Alcohol | |
Current significant intake | 9 (4.9) |
Duration of prehabilitation (day) | 19.29±14.87 |
Compliance | |
Reported doing at least the minimum sets prescribed | 61 (65.6)a) |
Able to demonstrate all exercises correctly during pre-operative follow-up | 81 (65.9)b) |
Source of referrals | |
Inpatient | 57 (31.3) |
Outpatient | 125 (68.7) |
Table 3.
Outcome measure | Baseline | Pre-operative | Improvement | p-valuea) | |
---|---|---|---|---|---|
Functional (physical) | |||||
6-minute walk test (m) | 303.94 (285.66–322.22) | 325.46 (305.14–345.77) | 21.52 | <0.001 | |
308 (234, 365) | 326 (251, 402) | ||||
30-Second Sit to Stand test (reps) | 10.99 (10.23–11.76) | 12.07 (11.25–12.90) | 1.08 | <0.001 | |
10 (9, 13) | 11 (9, 14) | ||||
Timed Up and Go test (s) | 12.07 (10.87–13.27) | 11.24 (10.18–12.29) | 0.83 | 0.014 | |
10.9 (8.4, 14.8) | 9.5 (8.0, 12.4) | ||||
Psychological (score) | |||||
HADS depression | 2.93 (2.41–3.46) | 1.94 (1.46–2.43) | 0.99 points (34%) | <0.001 | |
HADS anxiety | 3.24 (2.63–3.86) | 2.53 (1.93–3.12) | 0.71 points (22%) | 0.027 | |
HADS total | 6.17 (5.17–7.16) | 4.40 (3.42–5.37) | 1.77 points (29%) | <0.001 | |
Health-related quality-of-life | |||||
EuroQol-5 dimension health score | 69.32 (65.96–72.68) | 76.36 (72.42–80.29)b) | 7.04 points | 0.001 |
Table 4.
Outcome measure | Pre-operative | Post-operative | Difference | p-valuea) | |
---|---|---|---|---|---|
Functional (physical) | |||||
6-minute walk test (m) | 305.94 (280.14–331.74) | 306.16 (280.39–331.92) | 0.22 | 0.964 | |
30-Second Sit to Stand test (reps) | 11.35 (10.29–12.42) | 11.43 (10.34–12.51) | 0.08 | 0.863 | |
Timed Up and Go test (s) | 12.24 (10.77–13.72) | 12.28 (10.96–13.59) | 0.04 | 0.939 | |
Psychological (score) | |||||
HADS depression | 2.31 (1.61–3.01) | 1.79 (1.22–2.36) | 0.52 points (23%) | 0.117 | |
HADS anxiety | 2.82 (1.99–3.65) | 1.46 (0.83–2.09) | 1.36 points (48%) | 0.001 | |
HADS total | 4.40 (3.42–5.38) | 2.34 (1.18–3.49) | 2.06 points (47%) | 0.003 |
Table 5.
Appendices
Appendix 1.
Prehabilitation protocol. Prehab, prehabilitation; PC, done by prehab coordinator; HADS, Hospital Anxiety and Depression Scale; EQ-5D, EuroQol-5 dimension; Physiatrist, done by physiatrist; CVM, cardiology; Ortho, orthopaedics surgery; BMI, body mass index; BADLs, Basic Activities of Daily Living.
![arm-22126i1.tif](/upload/SynapseXML/1041arm/thumb/arm-22126i1.gif)
Appendix 2.
Peri-treatment workflow. Op, operative; PC, prehabilitation coordinator; HADS, Hospital Anxiety and Depression Scale; Prehab, prehabilitation; EQ-5D, EuroQol-5 dimension.
![arm-22126i2.tif](/upload/SynapseXML/1041arm/thumb/arm-22126i2.gif)
a. Siting for further rehabilitation ( inpatient rehabilitation vs. outpatient vs. home)
b. Medical optimization
c. Reinforcement/adjustment of exercise prescription
a. Referral/communication to inpatient dietician
b. Referral/communication to inpatient physiotherapist
c. Referral to inpatient Rehab Team (only if required)
a. Appointments with Prehab Clinic (physiatrist/PC) in 3 months
b. Outpatient referral to physiotherapist/occupational therapist (only if required, after discussion with physiatrist)
a. Need for outpatient physiotherapy/occupational therapy referral (eg., in cases of functional decline)
b. Medical optimization
c. Nutritional assessment & need for outpatient dietician referral
d. Mental health assessment & need for further referral to medical social worker
e. Reinforcement/adjustment of exercise prescription