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‘Prehab’ helps patients recover from surgery faster

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Prehab Elyse Pratt Johnson

The literature backs up the benefits of ‘prehab,’ said Elyse Pratt-Johnson (left), a physiotherapist who works with patients before surgery to improve their fitness and function so they recover faster.

You’ve heard of ‘rehab’ but what about ‘prehab’?

“The name is not well known but the concept sure has had a positive uptake,” said Jane Brownrigg, Clinical Manager of Cardiac Rehabilitation at the Heart Institute, who launched the Cardiac Prehab program in December 2016. “In our Cardiac Rehab world, we have not come across any other centre in Canada offering this type of prehab programming.”

More and more, patients are working with physiotherapists before surgery, rather than just afterwards, to improve their fitness and function so they recover faster. Depending on the program, prehab may also involve screening for smoking and diabetes, counselling about what to expect before and after surgery, physical assessments or a walking and exercise program.

Kathleen Hanna, who has cystic fibrosis, worked with a physiotherapist and a personal trainer before her double-lung transplant surgery, building up her shoulder, chest and back muscles, and improving her cardio.

“I was in the best shape I could be while I was sick, so that really helped me when it came to the transplant,” said Hanna, who prepared here at The Ottawa Hospital, but had the surgery in Toronto. “I wasn’t just lying around at home. In Toronto, they were glad I was able to do the exercises.”

Kathleen Hanna

Kathleen Hanna, who has cystic fibrosis, built up her shoulder, chest and back muscles, and improved her cardio before her double-lung transplant surgery, helping her to recover faster.

 “Absolutely, prehab helps these patients,” said Elyse Pratt-Johnson, a physiotherapist who works with thoracic surgery patients like Hanna. “When you’re going into surgery, it’s kind of like the workout of your life. Your heart rate and oxygen needs will be up. So if you train for that workout, you will do better.”

The literature backs up the benefits of prehab, said Pratt-Johnson. A 2013 study of lung cancer patients found that 59 percent of patients initially considered ‘inoperable’ were moved to the ‘operable’ category after prehab exercise training. Those who did prehab also had shorter hospital stays.

Prehab includes more than just exercises. Physiotherapists Leslie Balkwill and Marcia O’Connor lead information sessions at the Riverside Campus for patients before their joint replacement surgery. In the one-time sessions – which began in 2007 – patients learn how to prepare themselves for surgery, for their hospital stay and going home; what equipment they might need at home; and exercises to do before surgery.

Jane Brownrigg

Patients who go through prehab are more likely to show up for rehab after their surgery, said Jane Brownrigg, who helped launch the Cardiac Prehab program at the Heart Institute in December 2016. Photo: Heart Institute.

 “Prehab is a time when they’re hungry for the information,” said Brownrigg. “When people get instructions immediately post-op, they don’t always retain the information.”

The Cardiac Prehab program is being evaluated, but an initial finding is that those who go through it are more likely to show up for Rehab after their surgery, which reduces the risk of mortality from any cause by 27 percent and cardiac mortality by 31 percent.

“We talk about the patient being part of the team but Prehab really puts our money where our mouth is,” said Brownrigg. “Before surgery, we really do need patients to be physically active, eat well, sleep as well as they can, monitor glucose levels, quit smoking, and take their medication as prescribed.”

 
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