Effectiveness of Tele-Prehabilitation in improving outcomes for patients with major abdominal and thoracic surgery compared to face-to-face prerehabilitation

Tele-prehabilitation: at an initial consultation, participants will receive a physical, nutritional, and psycho-social assessment via telehealth. The initial 60-minute face-to-face assessments will be carried out by the physiotherapist and the dietitian. The initial assessment will aim to obtain basic patient demographic data. Exercise tolerance, frailty, quality of life, and nutritional status (using a malnutrition screening tool) will be measured or recorded. Exercise prescription will be based on the 6-minute walk test (6MWT) and 1 repetition maximum (1RM) findings. A 60-minute exercise program will be offered in a group setting via Telehealth two days a week. The group class will have up to 5 patients at any time. If the class size gets bigger, then an additional class will be added to accommodate the remaining clients. It will consist of strength and endurance training, such as walking and upper and lower limb resistance training using resistance bands and the patient's own body weight. In addition, patients will also practice breathing exercises and forced expiratory techniques such as deep breathing exercises and coughing. Patients will exercise at moderate intensity guided by the Borg scale. Exercise attendance will be recorded on the patient's exercise sheet. Diet and nutritional advice will be provided by the dietitian based on individual nutritional screening results. A single 20-30 minutes consultation will be provided via Tele-health and dietary recommendations will be provided (via email or post). Provision for an individualised food diary will be outside the scope of this program. In addition to two days of supervised exercise, participants will be encouraged to complete a 30-45 minute home exercise program on any three days a week, which may include walking, upper limb and lower limb strengthening exercises and breathing exercises. The home exercise program will be recorded in the patient's home exercise diary (self-recorded). Education will be provided via pre-recorded education sessions by a dietitian, pain clinical nurse consultant (CNC), social worker, pharmacist, and physiotherapist where each education will be of 10-15 minute duration for patients to watch in their own time. patients will be encouraged to watch all the videos if possible and record in their home exercise program diary. The pre-recorded videos will be provided via a USB device or pre-loaded on a tablet device (to be provided to patients with no smart device). During telehealth consults, the physiotherapist will follow up with participants regarding questions arising from the education sessions and organise a telephone consult with the relevant professional if needed. Participants will also receive a comprehensive handbook covering all the information delivered in the education sessions, along with a home exercise program and exercise diary. This booklet is designed for this program by the health professionals who are involved in service delivery. The exercise program will be offered for 2-6 weeks (The duration will be based on the program start date till the date of surgery). The program duration will vary for each participant/client depending on the date of surgery.