Prehabilitation: high-quality evidence is still required

Lobo, Dileep N.; Skořepa, Pavel; Gomez, Dhanwant; Greenhaff, Paul L.

Abstract

Prehabilitation comprises multidisciplinary healthcare interventions, including exercise, nutritional optimisation, and psychological preparation, which aim to dampen the metabolic response to surgery, shorten the period of recovery, reduce complications, and improve the quality of recovery and quality of life. This editorial evaluates the potential benefits and limitations of and barriers to prehabilitation in surgical patients. The results of several randomised clinical trials and meta-analyses on prehabilitation show differing results, and the strength of the evidence is relatively weak. Heterogeneity in patient populations, interventions, and outcome measures, with a wide range for compliance, contribute to this variation. Evidence could be strengthened by the conduct of large-scale, appropriately powered multicentre trials that have unequivocal clinically relevant and patient-centric endpoints. Studies on prehabilitation should concentrate on recruiting patients who are frail and at high risk. Interventions should be multimodal and exercise regimens should be tailored to each patient's ability with longitudinal measurements of impact.

Citation

Lobo, D. N., Skořepa, P., Gomez, D., & Greenhaff, P. L. (2022). Prehabilitation: high-quality evidence is still required. British Journal of Anaesthesia, https://doi.org/10.1016/j.bja.2022.09.016

• Journal Article Type: Editorial
• Acceptance Date: Sep 29, 2022
• Online Publication Date: Nov 1, 2022
• Publication Date: Nov 1, 2022
• Deposit Date: Nov 15, 2022
• Publicly Available Date: Nov 2, 2023
• Journal: British Journal of Anaesthesia
• Print ISSN: 0007-0912
• Electronic ISSN: 1471-6771
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1016/j.bja.2022.09.016
• Keywords: Anesthesiology and Pain Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/13744362
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0007091222005517?via%3Dihub
• Additional Information: This editorial is based on a lecture delivered by DNL to the 49th World Congress of the International Society of Surgery in Vienna, Austria, August 2022