Minnella Enrico Maria, Bousquet-Dion Guillaume, Awasthi Rashami, Scheede-Bergdahl Celena, Carli Francesco
a Department of Anesthesia , McGill University Health Center , Montreal , Quebec , Canada.
Acta Oncol. 2017 Feb;56(2):295-300. doi: 10.1080/0284186X.2016.1268268. Epub 2017 Jan 12.
Multimodal prehabilitation is a preoperative conditioning intervention in form of exercise, nutritional assessment, whey protein supplementation, and anxiety-coping technique. Despite recent evidence suggesting that prehabilitation could improve functional capacity in patients undergoing colorectal surgery for cancer, all studies were characterized by a relatively small sample size. The aim of this study was to confirm what was previously found in three small population trials.
Data of 185 participants enrolled in a pilot single group study and two randomized control trials conducted at the McGill University Health Center from 2010 to 2015 were reanalyzed. Subjects performing trimodal prehabilitation (exercise, nutrition, and coping strategies for anxiety) were compared to the patients who underwent the trimodal program only after surgery (rehabilitation/control group). Functional capacity was assessed with the six-minute walk test (6MWT), a measure of the distance walked over six minutes (6MWD). A significant functional improvement was defined as an increase in 6MWD from baseline by at least 19 m. Changes in 6MWD before surgery, at four and eight weeks were compared between groups.
Of the total study population, 113 subjects (61%) underwent prehabilitation. Changes in 6MWD in the prehabilitation group were higher compared to the rehabilitation/control group during the preoperative period {30.0 [standard deviation (SD) 46.7] m vs. -5.8 (SD 40.1) m, p < 0.001}, at four weeks [-11.2 (SD 72) m vs. -72.5 (SD 129) m, p < 0.01], and at eight weeks [17.0 (SD 84.0) m vs. -8.8 (SD 74.0) m, p = 0.047]. The proportion of subjects experiencing a significant preoperative improvement in physical fitness was higher in those patients who underwent prehabilitation [68 (60%) vs. 15 (21%), p < 0.001].
In large secondary analysis, multimodal prehabilitation resulted in greater improvement in walking capacity throughout the whole perioperative period when compared to rehabilitation started after surgery.
多模式术前康复是一种术前的调节干预措施，包括运动、营养评估、补充乳清蛋白以及应对焦虑的技巧。尽管最近有证据表明术前康复可以改善接受结直肠癌手术患者的功能能力，但所有研究的样本量都相对较小。本研究的目的是证实先前在三项小规模人群试验中发现的结果。
对2010年至2015年在麦吉尔大学健康中心进行的一项单组试点研究和两项随机对照试验中纳入的185名参与者的数据进行了重新分析。将进行三模式术前康复（运动、营养和焦虑应对策略）的受试者与仅在术后接受三模式康复计划的患者（康复/对照组）进行比较。通过六分钟步行试验（6MWT）评估功能能力，该试验测量六分钟内行走的距离（6MWD）。显著的功能改善定义为6MWD较基线增加至少19米。比较两组术前、术后四周和八周时6MWD的变化。
在整个研究人群中，113名受试者（61%）接受了术前康复。术前康复组在术前期间6MWD的变化高于康复/对照组{30.0[标准差（SD）46.7]米对-5.8（SD 40.1）米，p<0.001}，术后四周[-11.2（SD 72）米对-72.5（SD 129）米，p<0.01]，以及术后八周[17.0（SD 84.0）米对-8.8（SD 74.0）米，p=0.047]。接受术前康复的患者中，术前体能有显著改善的受试者比例更高[68（60%）对15（21%），p<0.001]。
在大型二次分析中，与术后开始的康复相比，多模式术前康复在整个围手术期能使步行能力得到更大改善。
