PREHABILITATIONVIS IT WORTH OUR WHILE? To the Editor: Surgery is being performed at an increasing rate in Australia with almost 2.4 million cases in 2011 compared with just more than 2 million in 2007.1 Approximately 80% of cases are planned elective admissions.1 A major preoperative factor that determines postoperative neurologic and cardiac outcomes is having a low functional status.2 Almost intuitively then, efforts to Bupgrade[ a person_s level of function before surgery should produce better outcomes postoperatively. Frailty scores often include medical comorbidities and functional performance,3 but while most preoperative assessments focus on optimizing medical conditions, little is done to improve functional status. Prehabilitation is a term used to describe rehabilitation preoperatively in elective cases with the aim of reducing perioperative complications, shortening length of stay, and improving functional capacity.4 The reduced need for inpatient rehabilitation postoperatively will also aid in lightening the financial and logistical burden on the hospital system. Prehabilitation programs can vary considerably in type (cardiovascular vs. resistance training of extremities), site (total body exercise vs. muscle or joint specific), intensity, duration, and frequency (sessions per week).4 A systematic review of 21 studies including 17 randomized controlled trials of predominantly orthopedic patients (hip or knee arthroplasty) suggested that a period of prehabilitation could improve physical function and length of stay and improve pain scores postoperatively. However, there were obvious methodological flaws and risk of bias in most of these studies.4 A separate review that included many of the same trials concluded that prehabilitation did not have any benefits on postoperative outcome measures like function, quality-of-life,

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Letters to the Editor

or pain. This applies mainly to orthopedic patients as there are limited data on other surgical populations. Encouragingly, Bthere is evidence that prehabilitation may reduce admission to rehabilitation.[5 Amalgamated results so far are disappointing, although some individual studies show promise. The utility of prehabilitation requires more robust research before it becomes standard best practice. Although its maximal benefits are yet to be determined, it certainly offers very little detriments to health. REFERENCES 1. Australian Institute of Health and Welfare, Australian Hospital Statistics 2010-11, Chapter 10 Surgery in Australian Hospitals. http://www.aihw.gov.au/WorkArea/Download Asset. aspx?id=10737421837&libID=10737421837. Accessed February 27, 2015 2. Leung JM, Dzankic S: Relative importance of preoperative health status versus intraoperative factors in predicting postoperative adverse outcomes in geriatric surgical patients. J Am Geriatr Soc 2001;49:1080Y5 3. Ravaglia G, Forti P, Lucicesare A, et al: Development of an easy prognostic score for frailty outcomes in the aged. Age Ageing 2008;37:161Y6 4. Santa Mina D, Clarke H, Ritvo P, et al: Effect of total-body prehabilitation on postoperative outcomes: A systematic review and meta-analysis. Physiotherapy 2014;100:196Y207 5. Cabilan CJ, Hines S, Munday J: The effectiveness of prehabilitation or preoperative exercise for surgical patients: A systematic review. JBI Database of Systematic Reviews and Implementation Reports. http://joannabriggslibrary.org/index.php/ jbisrir/article/view/1885. Accessed February 27, 2015.

David S. Lim, MBBS Eastern Health, Victoria, Australia DOI: 10.1097/PHM.0000000000000316

Am. J. Phys. Med. Rehabil. & Vol. 94, No. 8, August 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Prehabilitation--Is It Worth Our While?

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