Prehabilitation

Prehabilitation, often referred to as “prehab,” is a proactive approach to healthcare that involves preparing and optimizing a patient's physical and psychological well-being before they undergo a medical procedure, surgery, or treatment. The primary goal of prehabilitation is to enhance a patient's overall health and resilience, reduce the risk of postoperative complications, and improve recovery outcomes. Prehabilitation can be applied in various medical contexts and typically includes the following components:

Assessment: The process begins with a thorough assessment of the patient's current health status, including their physical fitness, medical history, and any existing medical conditions. This assessment helps healthcare providers identify potential risks and areas that need improvement.

Multidisciplinary Team: A team of healthcare professionals collaborates to develop and implement a personalized prehabilitation plan for the patient. This team may include physicians, surgeons, physical therapists, occupational therapists, dietitians, and mental health specialists.

Physical Conditioning: Prehabilitation often involves a structured exercise program tailored to the patient's specific needs and capabilities. This may include strength training, cardiovascular conditioning, flexibility exercises, and balance training. The goal is to improve the patient's physical fitness and functional capacity.

Nutritional Optimization: Dietitians assess the patient's nutritional status and may recommend dietary modifications or supplements to ensure they are adequately nourished. Proper nutrition is vital for healing and recovery.

Psychological Support: Prehabilitation addresses the psychological aspects of preparation for a medical procedure. Patients may receive counseling, stress management techniques, and emotional support to reduce anxiety and improve mental well-being.

Education: Patients are educated about their upcoming procedure, what to expect during the recovery process, and the importance of adhering to the prehabilitation plan. Education helps empower patients to take an active role in their healthcare.

Lifestyle Modifications: Depending on the patient's specific needs, lifestyle changes may be recommended, such as smoking cessation, alcohol moderation, or weight management.

Monitoring and Progress Tracking: Throughout the prehabilitation process, healthcare providers monitor the patient's progress and adjust the plan as necessary. Regular assessments help ensure that the patient is making improvements in their physical and psychological well-being.

Surgical Timing: In some cases, prehabilitation may allow for the optimization of a patient's health to the point where surgery can be delayed until the patient is better prepared, reducing surgical risks.

Prehabilitation is particularly beneficial for individuals who are at higher risk due to factors such as age, chronic illnesses, or a sedentary lifestyle. By improving a patient's health and fitness before a medical procedure, prehabilitation aims to:

Reduce the risk of complications during and after surgery. Speed up recovery and rehabilitation. Enhance the patient's overall quality of life during the recovery period. Improve the patient's ability to return to their normal activities and daily life more quickly. Ultimately, prehabilitation is an essential component of patient-centered care that focuses on optimizing outcomes and well-being for individuals undergoing medical interventions.

• Synergistic integration of epidural spinal cord stimulation with robotic therapy and neurorehabilitation to facilitate functional recovery in chronic sensorimotor complete spinal cord injury: A case series
• Fasting and nutrition in neuroanesthesia and neurocritical care patients
• The Role of Preoperative Immunonutritional Scores in Predicting Complications After Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease
• What is the role of non-surgical clinicians in the assessment and management of degenerative cervical myelopathy? - Insights from the RECODE-DCM peri-operative rehabilitation incubator
• The Infinity Loop of Healthcare Innovation: Development of an Integrated Rehabilitation Pathway for Lumbar Fusion Surgery Through Design Thinking
• Anomia prehabilitation in temporal lobe epilepsy surgery: A pilot study
• Spirituality and neurosurgery: A salutogenic current perspective
• Comprehensive guidelines for prehabilitation in spine surgery

Iqbal et al. outline a review of frailty-based prehabilitation for patients undergoing spinal deformity surgery ¹⁾

Sorour et al. outline a review of preoperative, intraoperative, and postoperative considerations surrounding adult spinal deformity. Preoperative management topics include imaging, hemoglobin A1c levels before spine surgery, osteoporotic management, and prehabilitation. Topics surrounding intraoperative management include the use of antibiotics, liposomal bupivacaine, and Foley catheters. The authors also discuss postoperative questions surrounding analgesia, nausea and vomiting, thromboembolic prophylaxis, and early mobilization. Throughout their discussion, the authors incorporate enhanced recovery after surgery protocols to hopefully lead to future discussions regarding optimizing complex spinal patients ²⁾