Author of

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  OA08 - Putting the Patient at the Center: Holistic Patient Care (ID 156)

  • Event: WCLC 2020
  • Type: Oral
  • Track: Nursing and Allied Health Professionals
  • Presentations: 1
  • Moderators:
  • Coordinates: 1/30/2021, 11:45 - 12:45, Scientific Program Auditorium

  • 35447

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    OA08.04 - Providing Thoracic Prehabilitation during COVID-19: Review of a Virtual Model (ID 3614)

    11:45 - 12:45  |  Presenting Author(s): Stephanie Wynne
    • Abstract
    • Presentation
    • Slides

    Introduction
    

    Prehabilitation in lung cancer surgery has shown to improve exercise capacity and reduce post-operative complication rates, morbidity and hospital length of stay (Rosero et al, 2019; Boujibar et al, 2018; Steffens et al, 2018). Prehabilitation is predominantly delivered via supervised exercise programmes, however since the COVID-19 pandemic, capacity to deliver face-to-face hospital appointments has significantly reduced. Therefore, we present preliminary data from a new, virtual prehabilitation service for patients undergoing lung surgery at a busy National Health Service Trust in London.

    Methods
    

    20 patients were prospectively recruited from surgical lists over six weeks (15^th June-30^th July 2020). Each patient was offered a virtual prehabilitation assessment over video or phone. Assessment included outcomes that could be completed virtually: MRC Dyspnoea scale, physical activity levels (Godwin Leisure Time Exercise Questionnaire (GLTEQ), dietary needs, mood (Hospital Anxiety and Depression Scale (HADS) and fatigue (FACIT-fatigue). Exercise capacity was measured using the one minute sit to stand (STS) test.

    Following assessment, each patient received a personalised home-based exercise programme and a diary to monitor compliance. Written advice and counselling for specific symptom management was also provided. Virtual follow-up occurred weekly or fortnightly. An ‘end of prehabilitation’ (EOP) assessment was completed approximately three days before surgery to repeat outcome measures. Due to local policy changes during this pilot, some patients were permitted a one-off, face-to-face prehabilitation assessment, however intervention and follow-up continued virtually.

    Results
    

    Baseline characteristics: 65% of the cohort were female, with an average: age 68 years; MRC Dyspnoea scale: 2; FEV1 %predicted: 87.9 and performance status: 1. 45% had ≥5 comorbidities, 70% had a smoking history and 15% were classified as ‘vulnerable-mildly frail’ using the Rockwood Clinical Frailty Score. A walking exercise tolerance ≥500m was present in 80% of the cohort, yet only 40% were classified as ‘sufficiently active’ on the GLTEQ.

    Uptake and technology: 35% of participants received a virtual prehabilitation assessment, whilst 65% had this delivered face-to-face. The uptake rates for patients approached for virtual or face-to-face assessments were 64% and 100% respectively. 75% of participants had access to email and video technology, whilst 25% could only receive telephone calls and written handouts. Inability to access emails and video was noted in all patients ≥80 years of age, yet there was no association between lack of technology and higher comorbidities or frailty.

    At EOP there was no change in average MRC-Dyspnoea scale, HADS or fatigue levels. However, GLTEQ scores changed by an average of +45.9 points, with 100% of the cohort meeting recommended levels of physical activity. We observed an average change in one minute STS test scores of +5.1, exceeding the minimum clinically important difference of +3 (Vaidya et al, 2016).

    Conclusion
    

    Our findings demonstrate that virtual, home-based prehabilitation is feasible and may improve patients’ pre-surgical physical activity levels and exercise capacity. This is pertinent given ongoing uncertainty surrounding COVID-19 and its impact on face-to-face healthcare delivery. Further consideration regarding the delivery of safe and effective virtual prehabilitation to more elderly or vulnerable patients may be required.

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