Assessing Feasibility of a Largely Independent Patient-Centered Prehabilitation Program in Thoracic Surgery Patients
Feiran Lou1, *Arianna Markel2, *Lyle Suh2, *Kevin Dickson3, *Olivia Sears4, *Benjamin Palleiko2, *Samuel Feinberg1, Mark W. Maxfield1, Karl F. Uy1
1. Department of Surgery, UMass Memorial Healthcare, Worcester, MA, United States. 2. UMass Chan Medical School, Worcester, MA, United States. 3. Department of Surgery, Berkshire Medical Center, Pittsfield, MA, United States. 4. Department of Surgery, University of Virginia, Charlottesville, VA, United States.
Background: Surgical patients face unique physical and psychological stressors, at times leading to prolonged recoveries. Prehabilitation seeks to enhance the functional status of patients prior to surgery. Previously established prehabilitation programs have demonstrated utility in non-surgical and some surgical sub-specialties, such as colorectal and cardiac surgery. However, data regarding its use in thoracic surgery remains scarce. To be useful, prehabilitation should be feasible for both patients and the program, provide personal value to the participating individuals, and improve postoperative outcomes. We hypothesized that an independent, patient-centered prehabilitation program is feasible and beneficial to thoracic surgery patients.
Study Design: The prospective pilot study enrolled 26 patients who underwent lung resections or esophagectomies. Inclusion criteria were ? 18 years old, ECOG status ? 1, and capable of independent ambulation. Exclusion criteria included serious or unstable medical or psychiatric conditions, pregnant women, prisoners, and non-English speaking subjects.
The prehabilitation program was composed of a 2-4 weeks long program that provided video-based guidance in exercise, nutrition, stress management, and lifestyle modification. Following enrollment, patient baselines were established via in-office visits. Compliance with the program was assessed through a review of self-reporting logs. Satisfaction was determined via surveys delivered post-operatively.
Results: Of the 20 patients who have completed this pilot study, 2 (10%) were lost to follow-up. A patient satisfaction survey was completed by 12 of the 18 remaining patients (67%). On average, patients ranked their satisfaction regarding progress made in the program as 4.64 out of 5 (5 = very satisfied). They ranked the program overall 8.9 out of 10 (10 = excellent). Feasibility was assessed through program adherence and compliance, measured using total days of program participation and total days protocol logged. Patients participated on average for a total of 19.38 days and logged 18.5 days, yielding an average compliance of 96.4%.
Conclusions: This pilot study provides preliminary evidence that a largely independent patient-centered prehabilitation program can be implemented in a thoracic surgical setting and led to positive patient-reported outcomes. Further studies are needed to define the program's objective benefits in terms of postoperative outcomes.
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