WIREDGOV

A Public Health Wales study exploring prehabilitation interventions has identified that more research is needed to fully understand their effectiveness for improving patients’ health whilst waiting for surgery.  

In response to concerns over long waiting times after the covid pandemic, Welsh Government asked Public Health Wales to conduct a review of existing research exploring actions patients waiting for surgery can take to maintain and improve their health whilst waiting. This in turn may help speed up recovery and the overall effectiveness of the surgery.

Prehabilitation is an approach aimed at improving the health of patients before they undergo surgical procedures. Unlike rehabilitation, which focuses on recovery after surgery, prehabilitation focuses on preparing patients physically, mentally, and emotionally prior to their surgery. 

Prehabilitation interventions can involve things like;  

• Physical exercise  
• Nutritional counselling 
• Support to quit smoking 
• Stress management techniques 
• Education about the upcoming surgery and the patients postoperative expectations 

These interventions are designed to improve the patients' overall health and fitness, minimise the risks associated with surgery, and facilitate faster recovery post-surgery. 

The review looked at fifty-seven studies of adults waiting for surgery which measured the effectiveness of specific prehabilitation programmes for improving various pre-surgical physical, social, and mental health outcomes in patients.  

Most of the programs studied were designed for certain types of patients who were getting planned surgeries, like orthopaedic or heart surgeries. Notably, much of the evidence around the effectiveness of these interventions for maintaining or improving various health measures prior to surgery was found to be inconsistent or of poor quality, indicating the need for further research in this area. 

Despite the overall need for further research, some promising findings emerged from the review showing the potential benefits of various prehabilitation techniques for improving the health of patients while they wait for surgery: 

• Prehabilitation interventions to help people quit smoking showed some effectiveness in helping patients stop smoking in the 24 hours before surgery and reducing overall daily cigarette consumption in patients on surgical waiting lists. 
• Supervised strength-based exercises showed benefits in reducing pain and improving balance in patients waiting for orthopaedic surgery. 
• 'Using different methods to help patients change their behaviour, such as lifestyle counselling, were shown to help improve the mental health of patients waiting for coronary bypass surgeries' 

Amy Hookway, Principal Evidence and Knowledge Analyst at Public Health Wales yesterday said:

“While this review highlights a diverse range of interventions available for patients awaiting surgery, it also shows that some of the evidence for their effectiveness remains inconsistent. To help improve patient outcomes it's imperative that further studies are conducted to evaluate the effectiveness of these interventions.” 

The reviews findings are expected to help with policy development and allocation of resources in Wales, aiming to limit the ill-effects of long surgical waiting times on patient health and well-being. 

As waiting lists for planned surgeries continue to get longer in healthcare systems worldwide, studies like this provide valuable insights into potential ways to improve patient outcomes during the waiting period.  

With further research and evaluation, prehabilitation could play a significant role in improving patient health and reducing the burden on healthcare systems.