Starting virtual prehabilitation with older people undergoing surgery pre-operatively

There is a growing population of older adults undergoing surgery later in life. This group tends to have more complex medical backgrounds as well as being frailer and prone to poorer post op and functional outcomes. 

Prehabilitation is not a new concept and has been shown to increase outcomes within populations in cancer care and surgical pathways, however there is limited evidence evaluating prehabilitation specifically for older adults undergoing surgery.

Therefore, we set out with the aim to introduce a prehabilitation programme within our current perioperative care for the older person undergoing surgery (POPS) service to see if this would increase functional outcomes in our patients. 

We focused this on two benign patient pathways – orthopaedic and urology. Our programme included personalised goal setting sessions alongside weekly online video group exercise classes for 6 weeks. We compared the outcomes of this to a group of similar patients who were unable to join the classes but instead had exercises given to them to self-manage at home. Both groups had the same outcome measures completed pre-and post-intervention.

Our findings showed that exercise prescription alone increased activity levels however the prehabilitation programme resulted in statistically significant improvements in functional gains and activity engagement.  Neither exercise prescription nor prehabilitation had an impact on participants quality of life. 

Overall, our findings show that prehabilitation helps to improve function pre-operatively which may in turn help with reversing frailty and increasing outcomes for this population. Our programme also shows that a significant proportion of this population are able to engage with virtual video led classes. Further research is required at looking at longer term impact on length of stay and post operative outcomes.