Prehab, Simplified

Prehab, Simplified
September 27, 2015 Alene Nitzky

CNV00000005Though it’s fairly new, you might have heard the term “prehab” before, especially if you’ve been in any major cancer centers, or around orthopedic surgeons or physical therapists. Short for “prehabilitation”, it is used before treatment, to improve outcomes for patients after treatment, in various aspects of their lives, and to reduce health care costs and complications.

Prehab is a concept that is fairly new to oncology, has been demonstrated to be effective for lung cancer patients prior to surgery, and is being explored for other types of cancer treatments. If you’ve heard the term “neoadjuvant chemotherapy”, which is chemotherapy used before surgery, prehab is like neoadjuvant rehabilitation.

Some examples of using prehab are for knee and hip joint replacement surgery patients, improving upper body strength for the time when they can’t support their full body weight with their legs. It can also help patients prepare for hysterectomies or abdominal surgeries, to prevent pneumonia or blood clots during the period of inactivity after surgery. Learning before surgery to use an incentive spirometer-the little breathing apparatus they give you in the hospital- is an example of prehab.

Prehab is simply doing whatever is possible to prepare a person before they go through any kind of treatment for a disease, to maximize the likelihood that they will end up better off than if they had not been prepared beforehand. That preparation can include many different aspects of their lives, physical, mental, emotional, functional, and more.

While “prehab” is not universally covered by insurance companies, or even prescribed by doctors, you can do a lot on your own. To prepare for a surgery or any other treatment, it requires clear communication with your surgeons, doctors, nurses, and any other professionals on your treatment team.

When it comes to breast reconstruction, prehab is certainly an important consideration. What does your body need to be prepared for any surgeries? Do you need to strengthen certain muscles that will help you ahead of time? Do you need to make arrangements at home for frequently used items so it’s easier for you to do things independently during the early recovery period? Knowing you won’t be able to lift much weight or move in certain ways for a while, it will help to plan this ahead of time.

Do you need specific guidelines from your surgeon on how long to avoid certain activities? How will you know you’re ready to start exercising again?

Do you have a emotional support among the people closest to you- do they understand the process of losing a body part, then rebuilding one, the changes to your body and how that affects you emotionally as well as physically? Are they willing to be patient, accepting, nonjudgmental, and give you the time and space you need to cope with the changes?

No one ever wants to think that they might have cancer in the future or need reconstruction surgery. But you CAN prepare to recover faster and with fewer complications by being as healthy and active as possible all the time.

Education is prehab. Learning about reconstruction options can help prepare you for what’s ahead. You can discuss your needs ahead of time with your surgeon or their staff. They can give you an idea of what you will need during recovery, both strength-wise and function-wise, what you can do, what you’ll need to avoid, and for how long.

We haven’t done a good job of teaching people to think ahead. Cancer is still something that is so feared that we don’t teach about it, yet it’s something that will eventually affect nearly half the population!

The terror of a cancer diagnosis often means people rush into surgery decisions, when it may not be the best choice for them in the long run. There is no time for prehab if you get a diagnosis one week and get whisked into a mastectomy with expanders placed a week later.

The following guidelines, which we’ve heard so often for general health, are prehab.

  • If you smoke, stop.
  • If you’re overweight, lose weight.
  • If you eat a poor diet, improve your diet.
  • If you’re sedentary, start exercising.

However, if a person does not do these things regularly or know how to do them effectively , you cannot wait until a crisis is to expect to change established habits. You cannot tell people to do these things unless you can give them the guidance, skills and coaching to succeed and maintain the changes.

Education and healthy living are the best prehab. An educated public, able to make informed decisions about health care, knowing where to find good information, will be better equipped to think clearly, calmly, and make decisions when presented with a potentially life-threatening disease diagnosis.

It’s traumatic enough to find out you have cancer, but when you know more about it and are better prepared with information, you’ll be less at the mercy of relying on doctors to do the decision-making for you when it comes to things that will affect you the rest of your life.

You might be getting support on each arm, but you’re standing on your own two feet.

References

  1. American Academy of Orthopaedic Surgeons. 2014. Can physical therapy before hip, knee replacement surgery improve outcomes? Science Daily. October 7. www.sciencedaily.com/releases/2014/10/141007111225.htm
  2. http://www.apta.org/PTinMotion/News/2015/8/5/PreHabWaPost/
  3. Corder, M., Kenner, R., Sherwood, J., et al. 2015. Prehabilitation demonstrates decreased hospital length of stay in a small sample of thoracic oncology patients. Presented at the Oncology Nursing Society Congress.
  4. Silver, J.K., & Baima, J. 2013. Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options and improve physical and psychological health outcomes. American Journal of Physical Medicine & Rehabilitation, 92(8):715-27.

 

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