Pre-habilitation to your Rehabilitation

When it comes to physical therapy, most think of the rehabilitation process following an injury or surgery. However, that unwritten rule is not true. There have been numerous studies providing evidence for better outcomes with pre-habilitation and post-rehabilitation. Patients have shown far better outcomes following his/her whole rehabilitation process with pre-habilitation prior to surgical interventions such as a total hip or knee replacements and even in cases of deconditioning or cancer.

            In October 2014, the Journal of Bone & Joint Surgery published “Associations Between Preoperative Physical Therapy and Post-Acute Care Utilization Patterns and Cost in Total Joint Replacement,” which looked at hip- and knee-replacement cases within a 39-county Medicare hospital referral cluster. It concluded, “The use of preoperative physical therapy was associated with a 29% decrease in the use of any post-acute care services.” This translated, after adjusting for demographic variabilities and comorbidities, into cost reductions of $1,215—“driven largely,” the authors wrote, “by reduced payments for skilled nursing facility and home health agency care.”

            The following month, the journal Anesthesiology published “Prehabilitation Versus Rehabilitation: A Randomized Control Trial in Patients Undergoing Colorectal Resection for Cancer.” The study of 77 patients randomized to receive either prehabilitation 4 weeks before or rehabilitation in the 8 weeks after colorectal resection surgery concluded that “meaningful changes in postoperative functional exercise capacity can be achieved with a prehabilitation program.” The authors further posited that “the preoperative period may, in fact, be a more salient time to intervene, as patients are generally in a better physical condition…”

            “I use the analogy that people wouldn’t run a marathon without training for it,” says Tony Brosky, PT, DHS, SCS, a professor of physical therapy and assistant dean of the Lansing School of Nursing and Health Sciences at Bellarmine University in Louisville, Kentucky. “Total joint replacement is by no means a benign procedure. We know that a percentage of patients experience serious side effects and complications from these surgeries. So, I think we need to do everything we can as PTs to help people build a reserve capacity—physically and psychologically—to anticipate and prevent potential problems…”

            Brosky coauthored “Prehabilitation and Quality of Life Three Months After Total Knee Arthroplasty: A Pilot Study.” It looked at a group of 18 patients with knee osteoarthritis who randomly were assigned to a control or prehabilitation group, and found that “the prehabilitation group scored significantly higher than the population norms in 8 health-related quality of life measures that ranged from physical functioning and bodily pain to emotional and mental health…”

At Body Gears Physical Therapy, we advocate for the well-being and health of all patients’. As you can tell from the following references above, pre-habilitation is a highly important concept that is vastly underutilized. It is essential to educate within the medical field as well as to our patient’s the relevancy and importance of pre-habilitation. Because pre-habilitation is a newer concept in the medical field, it is imperative to advocate to all parties. Also, how can one deny better outcomes, fewer medical expenses, and improved overall health when discussing the importance of pre-habilitation!?

By Dr. Kane Thompson PT, DPT, ATC

Reference: Ries, Eric. Better Sooner and Later: Prehabilitation. PT inMotion. February 2016.