Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
WONG HL(1), WONG AMS(1), LAU SHC(2), WONG RKY(1), LEUNG AKP(1), CHU CWH(3), CHAN ACM(1)
Affiliation :
(1) Physiotherapy Department, Queen Elizabeth Hospital
(2) Allied Health Department, Hong Kong Children’s Hospital
(3) Department of Surgery, Queen Elizabeth Hospital
Introduction :
Enhanced Recovery After Surgery (ERAS) was launched at Queen Elizabeth Hospital (QEH) in October 2022, providing an enhanced care pathway for patients undergoing major surgery. At QEH, elective colorectal surgery accounted for a majority of procedures through the ERAS service. As a member of the ERAS team, a Physiotherapy prehabilitation programme (PTPP) was initiated to establish a baseline functional level and provide interventions that promote physical and psychological health, aiming to reduce the incidence or severity of future impairments.
Objectives :
To evaluate the effectiveness of the PTPP in optimizing physical and psychological health.
Methodology :
A retrospective longitudinal study was conducted in collaboration with the Department of Surgery, QEH. Patients, who were candidates for elective surgery for colorectal cancer, were referred for PTPP prior to their surgery, which composed of Physiotherapy assessment, patient education and empowerment, and supervised group exercise training to advocate a physically active lifestyle and optimize patients’ condition. Paired Sample t-test or Wilcoxon Signed Ranks Test was used to analyze the PTPP's optimization effect on the patients’ condition.
Result & Outcome :
From October 2022 to September 2023, forty-one patients (18 males, 23 females; mean age = 70.6 ± 8.9 years old) diagnosed with colorectal cancer completed the PTPP. On average, patients attended 9 sessions within 41 days prior to the operation day.
The result revealed that the PTPP significantly optimized patients' physical and psychological health before surgery. Cardiopulmonary fitness, measured by maximal short exercise capacity (MSEC) and relative peak oxygen consumption predicted from MSEC, significantly improved from 109 ± 41 to 118 ± 40W (p = 0.002) and from 20.5 ± 4.1 to 21.3 ± 4.4 mL/kg/min (p = 0.003) respectively. Functional fitness, determined by 6-Minute Walk Distance, also significantly improved from 377 ± 82m to 439 ± 75m (p < 0.001). Though colorectal cancer was progressing before surgery, the patients' body weight, appendicular skeletal muscle mass index measured by bioelectrical impedance analysis, and handgrip strength were maintained and had not deteriorated (p > 0.05). Health-related quality of life, evaluated by the total score of the Functional Assessment of Cancer Therapy-Colorectal questionnaire, improved from 93 to 102 (p = 0.001).
PTPP enhanced patient preparation for elective colorectal surgery by optimizing cardiopulmonary fitness, functional fitness, and psychological health while maintaining the body composition before surgery.
