Prehabilitation before Surgery | How it works

by Joon Nah   BScPT
Registered Physiotherapist
updated Mar 14, 2024

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What is Prehabilitation?

Prehabilitation is the proactive approach to a patient’s physical and psychological well-being that occurs before surgery or other major medical procedure. It is often shortened to “prehab” and in some ways is seen as the opposite to rehabilitation. Where rehab usually centres on reducing the negative effects of the trauma of surgery, prehab has a positive focus, helping patients optimize their current condition to help ensure the best possible outcomes following their procedure.

Simply put, prehabilitation involves a structured exercise program, specific advice and coaching to prepare you to be able to quickly recover following surgery. While prehabilitation is used with many different types of medical procedures, here we will focus on orthopaedic patients and those that would commonly work with physiotherapists.

 

What does orthopaedic prehabilitation consist of?

1. Assessment

This is one of the most important aspects of prehabilitation. A careful and thorough assessment takes in to consideration, your health status, the type of procedure you’ll be undergoing, specific areas of concern, and your unique goals after the surgery.

2. Structured exercise program

Following your assessment, your physiotherapist will develop a specific list of exercises that can include muscle strengthening, stretching, joint mobility, endurance and cardiovascular conditioning.

3. Balance, coordination and stability training

These are specialized exercises to promote a general awareness of where you are in space (typically from your vestibular system) and where your joints and limbs are (proprioception).

4. Cardiovascular program

A progressive routine to gradually improve activity tolerance and stamina, improve blood flow and fluid mobility and help with weight management.

5. Psychological counselling

Physiotherapists often work with psychotherapists to address common presurgical issues such as anxiety, depression, stress management and coping. Sessions are often delivered virtually and can be as few as a single appointment to full weekly support before and after the procedure. Therapists often use mindfulness and cognitive-behavioral strategies.

6. Nutrition

Our clinics have a dietician on our team that can be involved in collaborative care with our physiotherapists. Patients will have their current diet analyzed, looking for nutritional deficiencies and be provided with an optimal nutrition plan with their specific surgery and limitation in mind.

 

The benefits of prehabilitation

1. Improved outcomes after surgery

Studies have repeatedly shown that prehabilitation reduces post-surgical recovery time, improves mobility and independence, and allows patients to get back their usual activities of daily living more quickly.

2. Fewer post-op complications

Prehabilitation can limit common issues after surgery including poor wound healing, local or systemic infections and blood clots or other cardiovascular problems. For surgeries of the hip, knee, and ankle, there is a reduction in the risk of falls which is a common concern, particularly with weaker or elderly patients.

3. Faster discharge from the hospital

This leads to fewer in-patient spread infections, better patient satisfaction and psychology, cost savings to our medical system, and increased healthcare access for other patients.

4. Overall improved quality of life

Patients overwhelmingly reported improvements in quality of life measures compared to those who didn’t participate in prehabilitation. The most common benefits pointed to reduction in symptoms and a high degree of independence.

5. Improved long-term outcomes

The improvements noticed shortly after surgery often have benefits on a patient’s long term outlook. The mobility and strength gains continue to be higher than those without prehabilitation. This can lessen the effects of future health care problems and help you maintain independence and the ability to participate in physical activities for the rest of your life.

 

Prehabilitation: Things to consider

1. Patient participation and compliance

This is perhaps the biggest challenge to prehabilitation. Some surgeons and hospitals treat prehabilitation as a very minor aspect of the whole surgical process, and may simply provide a generic handout of a prehab routine. However, it is obvious that every patient is different in their health status, physical needs, and goals for after surgery, therefore a comprehensive prehabilitation program has much better outcomes.

Patients who do participate in prehabilitation also face the same challenge as any other physiotherapy patient, where not sticking to your exercises results in poorer outcomes.

2. A Prehab program specific to you

As mentioned throughout this article, you are unique and your challenges are specific to you. This means that a prehabilitation program must incorporate a thorough evaluation with specific impairments identified. Every patient’s prehab routine should be different in some way, and should be progressed by regular re-evaluations and with frequent feedback between the patient and the physiotherapist.

3. The knowledge and training of your prehab team

Physiotherapists should be trained and experienced in the surgical procedure you are undertaking. As well, convenient access to additional team members such as a psychotherapist and dietician can have a significant positive impact.

4. Access to care

Depending on your region, there may be limited or no public funding for prehabilitation. This means that high quality care relies on the private health care system and those without extended insurance benefits may find the costs challenging. In most cases, having even one or two sessions of prehabilitation can be much better than none at all.

 

Conclusion

Prehabilitation is a fairly new concept in healthcare, though it is quickly being recognized as an important part of the overall surgical process. The undeniable benefit of prehab means that it will continue to have a larger role in the recovery process, as it improves outcomes and reduces the cost to our health care system.