Prehabilitation for Surgical Procedures

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According to a 2015 study published in The Journal of Bone and Joint Surgery (JBJS), approximately 7 million Americans are living with a hip or knee replacement. Orthopedic procedures such as joint replacements and foot and ankle surgeries can evoke images of weeks of limited mobility, pain and frustration. An extended recovery time is one significant reason why many people put off these operations and experience anxiety about going under the knife.

But, with adequate mental and physical preparation, you can get back on your feet again in no time. This process is called prehabilitation, and numerous studies have shown the benefits of engaging in “prehab” before surgery or intensive treatment. In addition to orthopedic applications, this technique has also been used in cancer patients who are preparing for treatments like chemotherapy, radiation therapy and surgical treatments that can be very hard on the body.

Ensuring that you are in the best possible shape prior to going in for an operation has many benefits, but prehab takes time and dedication. This can be particularly challenging for a patient who is already experiencing limited mobility, pain or significantly reduced energy due to a serious illness. For example, it can be very difficult to find an appropriate exercise regimen for a patient who has elected to receive a full knee replacement because of severe arthritis pain.

It may seem counter-intuitive to use these joints and muscles before surgery, but it is one of the most effective ways to get your rehabilitation efforts started before you even need them. Experts recommend at least six weeks of mental and physical preparation pre-surgery. This can seem like a substantial commitment, but even if you only have a few days or weeks before your procedure, every bit of extra effort helps.

Here are a few things to know about prehabilitation:

  • It can reduce your need for post-operative care by nearly 30 percent. Another JBJS study published in 2014 found that physical therapy before a joint replacement can significantly reduce the amount of time and money spent in rehabilitation. The stronger your body is before any operation, the better prepared it is to heal afterwards. Prehab activities can shorten your hospital stay and reduce your need for assistance from home health care and placement in a skilled nursing facility or an inpatient rehabilitation center.
  • You can “train” for the rehab process. Recovery can be rigorous and require a lot of physical activity, usually accompanied by some level of pain or discomfort. Participation in targeted physical therapy exercises presurgery will help to improve a patient’s strength, flexibility and endurance, providing an early advantage when it is time for them to work on recovering. Foregoing prehab and starting from scratch post-surgery can mean more pain and a much longer healing process.
  • Exercise does not have to be rigorous. Many physical therapy locations have gentler or lower-intensity options such as yoga, Pilates or water-based activities. All of these workouts will reduce the risk of further injury while building strength and cardiovascular endurance.
  • Diet matters too. While strength, flexibility and cardio training are important, your eating habits matter too. Optimizing your nutritional intake before an operation means you will be equipped with the vitamins and nutrients needed for the healing process. In some studies on prehab, scientists even included protein supplements in participants’ diets. Each person’s nutritional needs can vary considerably (especially when it comes to older adults), so consult with your doctor or a dietician before using supplements or making substantial dietary changes. These professionals are qualified to assist in creating a healthy, personalized diet for each patient’s unique situation.
  • Prepare yourself mentally. Going under the knife is a nerve-racking experience for most people and tends to lead to a buildup of apprehension beforehand. Lower stress levels may contribute to a better outcome post-surgery, and regular physical activity is a proven method for decreasing tension and anxiety. Getting into a routine that includes exercise and proper nutrition helps reduce stress levels, which leads to a quicker recovery time. If you are feeling particularly anxious about your arrangements, try meditating, breathing exercises or other enjoyable activities that help you to decompress.

Of course, prehabilitation is only the beginning. Compliance in rehab following surgery is equally important, but many patients are less than enthusiastic about weeks of physical therapy or a stay at an inpatient facility.

"Some of the most important things a resident can do to obtain a full recovery is to stick to their routine, and be completely compliant with their medication and care," said Abelina Koselke, registered nurse at Rainier Rehabilitation in Puyallup, Washington.

If you’re preparing for surgery, there is no better time to start conditioning. Ask your physician about starting a fitness program. Rehabilitation facilities in your area may offer prehab programs and can help you get approval from Medicare or your insurance company. Medicare typically will only cover a certain amount of physical therapy services. If prehab puts you over the limit or your private insurance does not cover such therapeutic programs, there are a few options available. You can pay out of pocket, elect to make a few physical therapy appointments before your procedure to create a regimen to use on your own, or there may free pre-op courses available at your hospital.

Consult with your physician to see if they have any additional suggestions for prehab and rehab as well as coverage options. Your body and your mind will thank you for this extra TLC.

Dr. Amy Osmond Cook is the Executive Director of the Association of Skilled Nursing Providers, Marketing Director of North American Healthcare and a health/wellness columnist.

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1 Comments

Great article. Most of the people I've worked with didn't have an opportunity to prehab as their replacements were from breaks and immediate surgery and then they had rehab. I'm a big fan of therapy. I try to schedule therapy once a quarter for my aunt who is 89. Her neurologist recommended it to help with her dementia. Spreading it out throughout the year keeps her in good shape. She loves the interaction with the therapist and loves to show off. Of course it's only mildly uncomfortable, unlike after a surgery. If medicare were more proactive, they would encourage more therapy for prevention, like a flu shot. As you mentioned, fewer days in the hospital, fewer days in a rehab. It would pay for itself. So I guess that means WE have to be proactive and not blame it on the government. Oh darn.