What you need to know about prehabilitation

Most of us know the value of rehabilitation following a surgery, such as a joint replacement, and how it restores physical strength and function. What may be less familiar is the concept of rehabilitation prior to surgery, or “prehabilitation,” which is a growing trend in medicine.

Karen M. Pechman MD, Burke Rehabilitation & Research July 1, 2014

Prehabilitation, or pre-hab for short, is an exercise program designed to prepare a person physically and mentally for surgery to optimize the chance for a successful outcome and a quick recovery. It’s well known that the inactivity associated with surgery stresses the body and leads to a decline in physical function.

Generally, the more fit and active you are going into surgery the more likely you are to retain a higher level of function after surgery and rehab more quickly. Often, there is a period of waiting involved before a surgery and it’s this time that a person can use to get in the best shape possible.

prehabilitation Benefits of Pre-hab
Studies have shown that people who participate in pre-hab regain full function and get back to their daily activities and sports faster and more easily than people who don’t do pre-hab. Plus, they tend to have less post-operative pain and fewer complications. Participating in pre-hab can even result in a shorter hospital stay.

One of the biggest benefits of a pre-surgical conditioning program is that it enhances the effects of rehabilitation by training muscles in advance for the exercises that an individual will need to do post-operatively. This can help make the exercises more efficient and effective.

Today, prehabilitation is used to prepare for a variety of surgeries and major medical procedures including joint, cardiovascular, lung and colorectal surgeries. One of its newest applications is helping recently-diagnosed cancer patients prepare physically and emotionally for rigorous treatments, thereby reducing the incidence and/or severity of post-therapy impairments.

The practice of pre-hab is especially common in orthopedic surgery for both acute injuries, such as an ACL rupture, and chronic injuries, such as an osteoarthritic knee waiting for replacement. In both cases, the goal is to restore range of motion, strength and function to the joint. However, with acute injuries, the focus is on reducing swelling and retaining mobility while with chronic injuries, the focus is on correcting compensatory movement patterns that contribute to pain and weakness.

Is Pre-hab Right for You?
Most people facing a scheduled surgery can benefit from pre-hab. Normally, a medical doctor will refer a patient to a physical therapist who evaluates the individual for a pre-operative exercise program. Ideally, prehabilitation should be started at least 6 weeks prior to surgery to gain the most benefit.

While it can sometimes be difficult to convince a patient who is awaiting joint surgery—and already experiencing a lot of discomfort—to exercise, a carefully planned, individually-tailored program can actually improve mobility and ease pain. Having a co-existing condition such as cardiovascular disease or multiple joint problems may restrict how much conditioning can be done, but it doesn’t exclude a patient from suitability. Patients who are highly motivated and those who exercise regularly, regardless of their age, tend to be particularly good candidates for pre-hab. However, even the most fragile patients can usually gain improvement from a minimum of occupational therapy and education prior to surgery.

We Brits have a reputation for suffering in silence. But while our stiff upper lips are a source of national pride, our reluctance to speak out could be costing us our health. A staggering 80 per cent of British adults suffer frequent back pain, a study revealed recently. And doctors believe the number could actually be closer to 90 per cent, but that a taciturn 10 per cent never bother reporting their pain. Instead they suffer in silence under the impression that back pain is inevitable - even normal - and the rest of us walking wounded suffer with them. Think back pain is normal? It is not - and you CAN end it, says TenPilates founder David Higgins - but it's prehab NOT rehab. That is the key Mail online

We Brits have a reputation for suffering in silence. But while our stiff upper lips are a source of national pride, our reluctance to speak out could be costing us our health. A staggering 80 per cent of British adults suffer frequent back pain, a study revealed recently. And doctors believe the number could actually be closer to 90 per cent, but that a taciturn 10 per cent never bother reporting their pain.
Instead they suffer in silence under the impression that back pain is inevitable – even normal – and the rest of us walking wounded suffer with them. Think back pain is normal? It is not—and you CAN end it, says TenPilates founder David Higgins, but it’s prehab NOT rehab – that is the key. Mail Online

What to Expect from Pre-Hab
Like rehab, pre-hab is an individualized conditioning program designed to increase strength, stamina, range of motion and functional ability. Similarly, it requires a team effort involving the patient, medical doctors and physical and occupational therapists to maximize the benefits.

A typical pre-hab program involves a warm-up, cardiovascular activity, resistance training, flexibility exercises, and practice in the use of walking aides such as crutches and walkers. Education is another key component. Learning what to expect post-operatively in rehabilitation, returning to work and recreational and at-home activities can help a patient prepare psychologically for surgery and ease apprehension. As a result, patients gain confidence and are better able to set realistic post-operative goals.

In today’s economic climate there is a greater push for improved patient outcomes following surgery and shorter hospital stays. Increasingly, prehabilitation is being covered by insurance and HMO plans. However, there’s usually a limit to the number of sessions covered. If your insurance doesn’t cover pre hab, talk to your doctor. Some medical facilities offer pre-hab services as part of their pre-surgery education. If not, your doctor can suggest a program or put you in touch with a qualified physiatrist or physical therapist.

Source Burke Rehabilitation & Research

4 Undeniable Benefits of Prehabilitation
“I use the analogy that people wouldn’t run a marathon without training for it,” says Performance Health Scientific Advisory Committee member Tony Brosky PT DHS SCS. Last month, Brosky was featured in an article from the American Physical Therapy Association (APTA) covering the importance of prehabilitation of patients, specifically those undergoing cancer treatments and orthopedic operations.

by Rebecca Moore, Performance Health Academy March 7, 2016

Physical therapists who engage patients in ‘prehab’ activities are actively working to enhance outcomes post-treatment, and their efforts are definitely paying off in a number of ways.

The article pointed out multiple reasons why participating in prehab activities can help patients maximize healing, strength and overall recovery:

  • Prehabilitation is patient education. “Patients are educated on their specific impairments and functional deficits, so they can begin to work on those deficits prior to surgery.”
  • Prehabilitation boosts recovery after surgery and treatments. “Because patients know from their education that the new joint is stable, they quickly begin the early-activation process of movement that helps reduce swelling, initiates muscle contraction, increases range of motion, and reduces pain.”
  • Prehabilitation is a baseline. “Knowing the patient’s range of motion, strength and function preoperatively, through clinical examination and direct observation, allows the patient and physical therapist to more accurately set realistic postoperative goals.”
  • Prehabilitation gives cancer patients power. “Prehab affords a sense of control at a time in their life when they otherwise may feel helpless and overwhelmed. They’re taking an active role in their treatment which makes them feel more positive about their experience.”

Source Performance Health Academy

Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomised controlled trials, Li Wang, Myeongjong Lee, Zhe Zhang, Jessica Moodie, Davy Cheng, Janet Martin. BMJ Open 2016;6:e009857 doi:10.1136/bmjopen-2015-009857

Also see
Better Sooner and Later: Prehabilitation in PT in Motion
Prescribe EXERCISE not drugs to help treat ‘heart disease, diabetes, back pain and arthritis’, doctors told in Mail Online
Prehabilitation exercise for total knee replacement helps patients with severe end-stage arthritis in Performance Health Academy
Orthopedic Rehabilitation Program in Burke Rehab Hospital

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