Implementing a physiotherapy-led prehabilitation service and improving inpatient rehabilitation for people with complex colorectal cancer: a service evaluation project

Background/Aims Prehabilitation improves pre-operative functional status which improves post-operative outcomes. There is limited evidence on the role prehabilitation for people with locally advanced or recurrent colorectal cancer and because of the complex nature of the surgery, patients have particular need for optimisation and specialist rehabilitation. A service evaluation was implemented to evaluate the impact of prehabilitation and increased post-operative rehabilitation in those with locally advanced or recurrent colorectal cancer. Methods Exercise-based prehabilitation and an increase in inpatient rehabilitation was implemented for those referred to the complex colorectal cancer clinic (n=59). Hospital length of stay and number of inpatient physiotherapy contacts (therapy sessions) were collected between May 2021 and May 2022 and compared to retrospective data of 44 people who underwent surgery between 2018 and 2019 to help evaluate this project. A range of secondary outcome measures were also collected to assess the impact of prehabilitation, including the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core-30, 30-Second Sit-to-Stand Test, Duke Activity Status Index and a patient questionnaire. Paired sample t-tests were performed to compare the total hospital length of stay for all patients in the retrospective 2018–2019 data group with the prehabilitation data group from 2021–2022. Results A total of 59 patients entered the service between May 2021 and May 2022. A significant difference between the length of stay in the two groups was found (P<0.05, t=0.731). Improvements in the Sit-to-Stand Test and Duke Activity Status Index were demonstrated (P<0.001). Data from the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core-30 showed small but not significant reductions in the severity of physical, fatigue, pain and appetite functioning scales. For the more complex patients, average weekly inpatient physiotherapy contacts per person increased from three in 2018–2019 to seven in 2021–2022. Patient compliance and satisfaction was high following implementation of the service development project. Conclusions Prehabilitation improves pre-operative functional status and combined with effective inpatient rehabilitation, may reduce hospital length of stay for those undergoing complex colorectal cancer surgery. Implications for practice Services that offer surgery for locally advanced or recurrent colorectal cancer should consider implementing a prehabilitation programme to improve pre-operative functional status. For those undergoing more complex surgeries, increased post-operative rehabilitation provision should be considered, as combined with prehabilitation, it may reduce hospital length of stay.