Pilot Study of Evidence-Based, Pragmatic Home-Based Prehabilitation Program
Timothy L. Fitzgerald 1, Abdimajid Mohamed MD2, Laura Nicolais MD1, *Liam Trimbel MD1, *Amy Litterini DPT1
1Surgery, Maine Medical Center, Portland, ME; 2Surgery, Boston University, Boston, MA
Objective: To develop and implement a home-based prehabilitation program for frail patients with planned abdominal surgery. We hypothesized that this could be accomplished by utilizing the Delphi technique and safely executed in a pilot study enrolling only high-risk patients.
Design: A prehabilitation program was to be designed by a panel of seven academic physical therapists from different regions across the United States using the schema of a Delphi technique. Pre-specified objectives were a home-based prehabilitation exercise program requiring little/no equipment for frail patients with planned abdominal surgery. A prospective pilot study was conducted over a year in frail patients (as defined by the risk analysis index).
Setting: Academic Medical Center
Interventions: Delphi iterative process and prospective pilot study
Outcome measures: Iterative process results and patient compliance and safety
Results: A series of three Delphi iterations were conducted. Consensus determined that light cardiovascular, functional, and strength training were essential. Recommendations for daily light cardiovascular exercise (30 minutes), with an initial rate of perceived exertion (RPE) intensity of 3-5 on the Modified Borg scale and maximum intensity RPE 6-7. Every other day, strength training targeting major muscle groups and functional training was recommended (initial 1 set, maximum of 3; initial repetitions 10, with a maximum of 15). Based on these data, a pilot study was conducted in frail surgical oncology patients with a prehab kit (online program, written instructions, and required resistance bands) with a post-procedural survey. We enrolled 30 frail patients from 6/2022-6/2023, most initiating neoadjuvant therapy (20/30). 14 patients underwent surgery (Whipple-8, colectomy-3, gastrectomy-2, and liver resection-1), the majority (9/14) participated in the prehabilitation program. There were no reported safety issues. No patients completed the exercise log, and few accessed online educational material relying on paper handouts.
Conclusion: Using a Delphi Method, a pragmatic home-based prehabilitation exercise regimen with light cardiovascular, strength, and functional training was developed. In a pilot study, most surgical patients completed the prehabilitation program without safety issues. However, few accessed online resources or completed required exercise logs. Future studies will leverage the electronic health record to improve virtual accessibility and compliance documentation.
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