Authors (including presenting author) :
So KY(1),Au TK(1),Choi WW(1),Fan SM(1),Fung YK(1),Tam KS(1),Tam WY(2),Yuen KY(2)
Affiliation :
(1)Physiotherapy Department; (2)Department of Surgery, Tseung Kwan O Hospital(TKOH)
Introduction :
Enhancement of post-operative recovery has gained increasing attention in the recent decade. It is evident that poor baseline physical performance increases the risk of complications after major surgery, resulting in prolonged recovery to pre-operative level up to >8weeks.
Physiotherapy plays an important role in pre-habilitation and post-operative care. A structured exercise program before major abdominal surgeries could optimize physical fitness, therefore achieving pre-operative optimization, modifying certain risk factors and allowing patients to be primed for the stressful post-operative recovery. Furthermore, post-operative early mobilization could improve mobility and functional independence. After hospital discharge, these patients could return to their baseline functional levels more efficiently.
Objectives :
1. To optimize physical fitness of patients before elective colorectal surgeries by pre-habilitation
2. To enhance patients’ recovery of physical fitness after colorectal surgeries
Methodology :
Colorectal cancer patients at TKOH were referred for risk stratification by six-minute walk test(6MWT) and hand grip strength(HGS). Patients with 6MWT distance under 350meters and 400meters were triaged as high-risk and moderate-risk group respectively. Those with HGS below normative data and multiple comorbidities were also referred for pre-habilitation before surgeries.
Pre-habilitation commenced twice weekly about 4weeks before operation. Each session contained prophylactic chest physiotherapy and individualized aerobic and resistance exercise according to risk stratification. During hospitalization, daily early mobilization and chest physiotherapy started on post-operative day(POD)1. Structured outpatient rehabilitation training was provided twice weekly after discharged. Reassessment of 6MWT and HGS repeated within 4weeks post-operatively.
Result & Outcome :
From August to November 2019, 49patients were assessed. Nineteen were triaged as high or moderate-risk patients and 10(male=7;female=3) have completed pre-habilitation and post-operative rehabilitation with 100%compliance. The mean age was 72.7. During the inpatient period, the average length of stay(LOS) was 9.5days. No patients resulted in post-operative pulmonary complications or unplanned readmission. After pre-habilitation, the performance of 6MWT and HGS was 18% and 5% greater than the baseline respectively. Within 4weeks post-operatively, the performance of 6MWT was 11% greater, while HGS was similar to the baseline level respectively. There was no adverse event during pre-habilitation and post-operative rehabilitation. Physiotherapy pre-habilitation was effective to optimize physical fitness of patients before planned colorectal surgeries and enhance their recovery to pre-operative level after surgery more efficiently.
