Functional results and feasibility of a teleprehabilitation program in patients who are candidates for elective colorectal cancer surgery during the COVID‐19 pandemic

Abstract

AimTo assess the value of a prehabilitation program adapted to the current COVID‐19 pandemic using a teleprehabilitation modality in a public Latin American hospital.MethodsThe medical records of candidates for elective colorectal cancer surgery (CRC) and who completed a teleprehabiltation program were analyzed. Sociodemographic, clinical, and functional variables were analyzed, such as cardiorespiratory capacity with the sit‐to‐stand test (STST), independence in activities of daily living with the Barthel index, balance with the five‐times STST (FSTST) and fatigue with Brief Inventory Fatigue (BFI). The feasibility of the program was analyzed in terms of recruitment, retention, user satisfaction, and reporting of adverse events.ResultsOf 107 people recruited, 57 completed the program (54%, 68.78 ± 12.36 years). There was a significant difference in the BFI, FSTST, and STS 1‐min scores after the intervention (p < .01), with an effect size (Cliff's delta) that varied between −.13 and .21. There were no differences in the Barthel index score. In relation to the viability of the program, 99% of patients referred for surgery could be recruited into the program, with 53% retention. Regarding user satisfaction with the program, seven items (77.7%) were rated as “very satisfied,” and two items (22.3%) as “satisfied.” No adverse events were recorded.ConclusionThe structured prehabilitation program adapted to teleprehabilitation for CRC candidates for surgery was effective in optimizing functional results prior to surgery and was feasible to implement in a public hospital with limited resources during the COVID‐19 pandemic.

Research Priorities in Prehabilitation for Patients Undergoing Cancer Surgery: An International Delphi Study

“…Other priorities identified, including ‘modes of delivery for prehabilitation’ and ‘prehabilitation during neoadjuvant therapies’, aligned with current trends in cancer surgery. For example, telehealth, which gained popularity as a treatment modality, especially following the covid pandemic, 22 , 23 represents a vital technological tool in the delivery of healthcare. Additionally, as the implementation of neoadjuvant oncological therapy in pathologies, such as rectal and oesophageal cancer, expands, 24 , 25 the safety of prehabilitation during this treatment will require evaluation.…”

The use of technology in cancer prehabilitation: a systematic review

“…Among the 16 included studies, four were controlled intervention studies [one rated good (90), two fair (91,92), and one poor (93)]. Twelve were pre-post studies [ten were fair with some bias risk (16,88,(94)(95)(96)(97)(98)(99)(100)(101) and two with significant risk (89,102)]. Due to their heterogeneity and limited large-scale studies, three poor-quality studies were included in the qualitative analysis (Table 2).…”

“…The third study involved telehealth that delivered a multimodal home-based prehabilitation program involving exercise, nutrition, medical optimization and psychological support (16). Another study utilized video-conferencing for teleprehabilitation via the zoom platform or a videocall on the smart phone (100). The fifth involved tele-conferencing either through an app or on the web coupled with a wearable tracker for remote monitoring (99).…”

“…Physical functional outcomes reported were heterogenous, with 6MWT (91,94), the incremental shuttle walk (89), sit-to-stand test There is a trend towards a lower proportion of improvement in the physical domain when wearables are deployed as the sole technological enabler. Physical intervention may translate into improvements in the psychological and quality of life domains without mental health interventions (95,100) (Table 4).…”

“…One study reported more exercise sessions in the application group than in the conventional group despite a shorter wait time to surgery (89). One unintentional convenience sample reported 54% completion and 53% retention, deemed feasible but raising potential selection bias concerns (100). Another also raised concerns due to high drop-out rate of 48% with reasons of inadequate step data obtained, withdrawal and protocol deviation (93).…”