At Hamilton Health Sciences (HHS), ensuring patients are well prepared for orthopedic surgery is often as important as the surgery itself. For the past two years, HHS’ Henderson General Hospital has been running a Prehabilitation Program for patients facing total joint replacement with some amazing results. In some cases, patients respond so well to the program that they are able to defer or indefinitely postpone the surgery they may have otherwise needed.
Orthopedic surgeons refer patients to the prehab program in order to help prepare them for their surgery and eventual recovery. Working with a team of health-care professionals including doctors, physiotherapists, occupational therapists, nutritionists, physiotherapy assistants and social workers, the patient learns what he or she needs to know prior to undergoing surgery as well as what they will need to do to successfully recover afterwards.
“We look at the whole person and try to understand all aspects of the person’s lifestyle,” said Mary Knapman, case manager for the prehab program. “By doing this, we can determine what they will need to do prior to the surgery and get them started on exercise and nutrition programs that will help get them through the surgery and on the road to recovery faster.”
In only two years, the program has already proven its success. A research study is currently underway to evaluate data related to the program; however, Knapman said in six to eight per cent of cases, the preconditioning program works so well, patients are able to delay or indefinitely postpone surgery. This is simply because the program gets patients moving and challenges them to make healthy lifestyle choices, including diet and exercise, that they can live with.
All patients are seen by Dr. Andrew Gwardjan, a rehab specialist, who follows their care through the program. In most cases, patients attend the program three times a week for between one and three hours for up to six weeks prior to their surgery. This gives staff working with the patients a chance to get to know them and assess their needs while also affording patients the opportunity to ask questions that will help them understand the process and the important role they have to play in it.
“We’ve had a lot of nice compliments from our patients,” Knapman said. “Once they realize the benefits of the program and they start feeling better, they find the experience very satisfying.”
In addition to preparing patients for surgery, the program also focuses on the recovery process. Potential mobility issues are addressed early on so patients know what type of equipment they may need to rent or purchase in order to help with recovery. Learning to use this equipment in advance also helps patients feel more comfortable following surgery when their mobility is initially more challenged than ever.
“After surgery they already know some of the exercises they need to do and we’ve helped them plan for other challenges like transportation,” Knapman said.
Orthopedic surgeons at HHS credit the prehab program for improving length of stay times following surgery and enabling them to perform many surgeries each year. The fact that patients coming through the program feel prepared and ready for surgery both physically and mentally is an important factor and one that is attributable entirely to the patient’s involvement in the process through the prehab program.
On average, about 30 patients take part in the prehab program each month. A staff of approximately six caregivers works with all the patients and Knapman says much of the program’s success is a result of the team’s ability to work well together and provide valuable input about different components of the care process.
Although the program is still relatively new, Knapman is confident the statistics will support its success and may inspire other hospitals and programs to adopt a similar model to meet the needs of their patients.
“All of our patients are extremely happy and complimentary,” Knapman said. “It’s nice to know that you’re helping them and when you see them getting back to normal lives in their communities without facing problems it’s extremely rewarding.”