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Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer.
Anesthesiology 2014; 121(5):937-47A

Abstract

BACKGROUND

The preoperative period (prehabilitation) may represent a more appropriate time than the postoperative period to implement an intervention. The impact of prehabilitation on recovery of function al exercise capacity was thus studied in patients undergoing colorectal resection for cancer.

METHODS

A parallel-arm single-blind superiority randomized controlled trial was conducted. Seventy-seven patients were randomized to receive either prehabilitation (n = 38) or rehabilitation (n = 39). Both groups received a home-based intervention of moderate aerobic and resistance exercises, nutritional counseling with protein supplementation, and relaxation exercises initiated either 4 weeks before surgery (prehabilitation) or immediately after surgery (rehabilitation), and continued for 8 weeks after surgery. Patients were managed with an enhanced recovery pathway. Primary outcome was functional exercise capacity measured using the validated 6-min walk test.

RESULTS

Median duration of prehabilitation was 24.5 days. While awaiting surgery, functional walking capacity increased (≥ 20 m) in a higher proportion of the prehabilitation group compared with the rehabilitation group (53 vs. 15%, adjusted P = 0.006). Complication rates and duration of hospital stay were similar. The difference between baseline and 8-week 6-min walking test was significantly higher in the prehabilitation compared with the rehabilitation group (+23.7 m [SD, 54.8] vs. -21.8 m [SD, 80.7]; mean difference 45.4 m [95% CI, 13.9 to 77.0]). A higher proportion of the prehabilitation group were also recovered to or above baseline exercise capacity at 8 weeks compared with the rehabilitation group (84 vs. 62%, adjusted P = 0.049).

CONCLUSION

Meaningful changes in postoperative functional exercise capacity can be achieved with a prehabilitation program.

Authors+Show Affiliations

From the Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada (C.G., R.A., B.A.); and Department of Surgery (C.L., L.L., A.S.L., B.S., P.C., L.S.F.) and Department of Anesthesia (A.G., F.C.), McGill University, Montreal, Quebec, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25076007

Citation

Gillis, Chelsia, et al. "Prehabilitation Versus Rehabilitation: a Randomized Control Trial in Patients Undergoing Colorectal Resection for Cancer." Anesthesiology, vol. 121, no. 5, 2014, pp. 937-47.
Gillis C, Li C, Lee L, et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology. 2014;121(5):937-47.
Gillis, C., Li, C., Lee, L., Awasthi, R., Augustin, B., Gamsa, A., ... Carli, F. (2014). Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology, 121(5), pp. 937-47. doi:10.1097/ALN.0000000000000393.
Gillis C, et al. Prehabilitation Versus Rehabilitation: a Randomized Control Trial in Patients Undergoing Colorectal Resection for Cancer. Anesthesiology. 2014;121(5):937-47. PubMed PMID: 25076007.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. AU - Gillis,Chelsia, AU - Li,Chao, AU - Lee,Lawrence, AU - Awasthi,Rashami, AU - Augustin,Berson, AU - Gamsa,Ann, AU - Liberman,A Sender, AU - Stein,Barry, AU - Charlebois,Patrick, AU - Feldman,Liane S, AU - Carli,Francesco, PY - 2014/7/31/entrez PY - 2014/7/31/pubmed PY - 2014/12/17/medline SP - 937 EP - 47 JF - Anesthesiology JO - Anesthesiology VL - 121 IS - 5 N2 - BACKGROUND: The preoperative period (prehabilitation) may represent a more appropriate time than the postoperative period to implement an intervention. The impact of prehabilitation on recovery of function al exercise capacity was thus studied in patients undergoing colorectal resection for cancer. METHODS: A parallel-arm single-blind superiority randomized controlled trial was conducted. Seventy-seven patients were randomized to receive either prehabilitation (n = 38) or rehabilitation (n = 39). Both groups received a home-based intervention of moderate aerobic and resistance exercises, nutritional counseling with protein supplementation, and relaxation exercises initiated either 4 weeks before surgery (prehabilitation) or immediately after surgery (rehabilitation), and continued for 8 weeks after surgery. Patients were managed with an enhanced recovery pathway. Primary outcome was functional exercise capacity measured using the validated 6-min walk test. RESULTS: Median duration of prehabilitation was 24.5 days. While awaiting surgery, functional walking capacity increased (≥ 20 m) in a higher proportion of the prehabilitation group compared with the rehabilitation group (53 vs. 15%, adjusted P = 0.006). Complication rates and duration of hospital stay were similar. The difference between baseline and 8-week 6-min walking test was significantly higher in the prehabilitation compared with the rehabilitation group (+23.7 m [SD, 54.8] vs. -21.8 m [SD, 80.7]; mean difference 45.4 m [95% CI, 13.9 to 77.0]). A higher proportion of the prehabilitation group were also recovered to or above baseline exercise capacity at 8 weeks compared with the rehabilitation group (84 vs. 62%, adjusted P = 0.049). CONCLUSION: Meaningful changes in postoperative functional exercise capacity can be achieved with a prehabilitation program. SN - 1528-1175 UR - https://www.unboundmedicine.com/medline/citation/25076007/Prehabilitation_versus_rehabilitation:_a_randomized_control_trial_in_patients_undergoing_colorectal_resection_for_cancer_ L2 - http://anesthesiology.pubs.asahq.org/article.aspx?doi=10.1097/ALN.0000000000000393 DB - PRIME DP - Unbound Medicine ER -