Feasibility of a tele-prehabilitation program in high-risk patients with colon or rectal cancer undergoing elective surgery: a feasibility study

Abstract

Background Prehabilitation appears to be an effective strategy to reduce postoperative complications and enhance recovery after colorectal surgery. Although many patients prefer (unsupervised) home-based prehabilitation, adherence can be problematic. Combining home-based prehabilitation with tele-monitoring might demonstrate a higher adherence than unsupervised prehabilitation; however, evidence on its feasibility and effectiveness in patients with colorectal cancer scheduled for elective surgery who are at high risk for postoperative complications is lacking. The aim of this study was to assess the feasibility of a bimodal tele-prehabilitation program in patients with colorectal cancer at high risk for postoperative complications. Methods High-risk patients (oxygen uptake at the ventilatory anaerobic threshold ≤11 mL/kg/min or oxygen uptake at peak exercise ≤ 18 mL/kg/min) with colorectal cancer were included in a home-based bimodal tele-prehabilitation program. The program consisted of a personalized tele-monitored moderate to high-intensity interval training intervention and nutritional counseling. Feasibility was measured by participation rate, dropout rate, adherence to the physical exercise training session’s frequency, intensity, and time, and retention rate. Patient appreciation was measured by a patient appreciation questionnaire. Changes in preoperative physical fitness as secondary outcomes were quantified by time to exhaustion on a constant work rate (cycle) test, number of repetitions on the 30-s chair-stand test, and walking speed on the 4-m gait speed test. Results The participation rate was 81%, there were no adverse events, and all participants managed to complete the tele-prehabilitation program (retention rate of 100%). Adherence with regard to the exercise program’s frequency, intensity, and time was respectively 91%, 84%, and 100%. All participants appreciated the tele-prehabilitation program. Time to exhaustion on the constant work rate test improved (not statistically significant) from a pre-prehabilitation median score of 317 seconds to a post-prehabilitation median score of 412 seconds (p = 0.24). Median number of repetitions on the 30-s chair-stand test improved from 12 to 16 (p = 0.01). Conclusions Tele-prehabilitation seems feasible in high-risk patients with colorectal cancer, but efforts should be made to further improve adherence to physical exercise training intensity. More research is needed to establish the (cost-)effectiveness of tele-prehabilitation regarding preoperative improvements in preoperative aerobic fitness and postoperative reduction of complications. Trial registration ISRCTN, ISRCTN64482109. Registered 09 November 2021 - Retrospectively registered.

Preparing for colorectal surgery: a feasibility study of a novel web‐based multimodal prehabilitation programme in Western Canada

“…programme. This result was comparable to findings of similar feasibility studies that showed a similar proportion of patients reporting prehabilitation as easy to use (including wearable technology), pleasant and positively rated overall [35,36].…”

“…The high website visitation rates of 71% reported by patients were reflective of findings from previous feasibility studies on telehealth‐delivered prehabilitation programmes which found adherence rates of >80% [35] and 71% [31]. The high participation rate of accessing the website may be attributed to the self‐directed nature of the website, where patients had the flexibility to access the website on their own schedule with minimal active supervision, concordant with earlier work [23].…”

Effect of short-term prehabilitation of older patients with colorectal cancer: A propensity score-matched analysis

“…These findings suggest that although prehabilitation can potentially improve physiological reserve and functional capacity to promote early recovery, low adherence to prehabilitation can hinder the effectiveness of prehabilitation interventions. The compliance of 83.2% in the current prehabilitation program was comparable to the compliance in the previous multimodal tele-prehabilitation program (81%) ( 37 ) and was higher than that of the community-based prehabilitation program (56%) ( 38 ). Despite a short prehabilitation day, we demonstrated some improvement in the short-term clinical outcomes of older patients with CRC, suggesting that, for patients with short preoperative duration, preoperative implementation of short-term prehabilitation is a feasible and effective option to ensure patient compliance.…”

Influence of different data-averaging methods on mean values of selected variables derived from preoperative cardiopulmonary exercise testing in patients scheduled for colorectal surgery

“…This observational cross-sectional study was performed at the VieCuri Medical Center, a large teaching hospital in Venlo, the Netherlands. The current study was executed as a secondary analysis of data collected in a study [14] that was approved by the Medical Ethics Review Committee-Zuyderland/Zuyd (Heerlen, the Netherlands) under reference number METCZ20190150. Reporting was done using the STROBE guidelines for reporting of cross- Visualization of the plot with oxygen uptake (VO 2 ) and carbon dioxide production (VCO 2 ) over time without data-averaging (graph A) and using the five different data-averaging intervals: a stationary time-based average of 10 seconds (graph B), 20 seconds (graph C), and 30 seconds (graph D), a rolling average interval of 3 breaths (graph E) and 7 breaths (graph F) in patient 21.…”

“…Data from consecutive patients considered for colorectal cancer surgery who were �18 years of age, had a score �7 metabolic equivalents of task on the veterans-specific activity questionnaire, and therefore performed preoperative CPET as a part of a tele-prehabilitation study [14], were collected between July 2020 and September 2021. All patients signed informed consent.…”