Barberan-Garcia Anael, Cano Isaac, Bongers Bart C, Seyfried Steffen, Ganslandt Thomas, Herrle Florian, Martínez-Pallí Graciela
Prehabilitation Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Front Oncol. 2021 Jun 17;11:662013. doi: 10.3389/fonc.2021.662013. eCollection 2021.
Prehabilitation has shown its potential for most intra-cavity surgery patients on enhancing preoperative functional capacity and postoperative outcomes. However, its large-scale implementation is limited by several constrictions, such as: i) unsolved practicalities of the service workflow, ii) challenges associated to change management in collaborative care; iii) insufficient access to prehabilitation; iv) relevant percentage of program drop-outs; v) need for program personalization; and, vi) economical sustainability. Transferability of prehabilitation programs from the hospital setting to the community would potentially provide a new scenario with greater accessibility, as well as offer an opportunity to effectively address the aforementioned issues and, thus, optimize healthcare value generation. A core aspect to take into account for an optimal management of prehabilitation programs is to use proper technological tools enabling: i) customizable and interoperable integrated care pathways facilitating personalization of the service and effective engagement among stakeholders; ii) remote monitoring (i.e. physical activity, physiological signs and patient-reported outcomes and experience measures) to support patient adherence to the program and empowerment for self-management; and, iii) use of health risk assessment supporting decision making for personalized service selection. The current manuscript details a proposal to bring digital innovation to community-based prehabilitation programs. Moreover, this approach has the potential to be adopted by programs supporting long-term management of cancer patients, chronic patients and prevention of multimorbidity in subjects at risk.
术前康复已显示出其对大多数腔内手术患者在增强术前功能能力和改善术后结果方面的潜力。然而，其大规模实施受到多种限制，例如：i）服务流程中未解决的实际问题；ii）协作护理中与变革管理相关的挑战；iii）术前康复的可及性不足；iv）项目退出的相关比例；v）项目个性化的需求；以及vi）经济可持续性。术前康复项目从医院环境转移到社区可能会提供一个更易获得的新场景，同时也提供了一个有效解决上述问题的机会，从而优化医疗价值的产生。术前康复项目最佳管理需要考虑的一个核心方面是使用适当的技术工具，以实现：i）可定制且可互操作的综合护理路径，促进服务个性化以及利益相关者之间的有效参与；ii）远程监测（即身体活动、生理体征以及患者报告的结果和体验指标），以支持患者坚持项目并增强自我管理能力；iii）使用健康风险评估来支持个性化服务选择的决策制定。本手稿详细介绍了一项将数字创新引入基于社区的术前康复项目的提议。此外，这种方法有可能被支持癌症患者长期管理、慢性病患者管理以及高危人群多重疾病预防的项目所采用。
