Authors (including presenting author) :
Hui WH (1), Lau AYC (2), Hung ALH (2), Yeung KC (1), Chan NC (1), Chan CY(1), Siu HK (1), Tsang SMH (1)(3)
Affiliation :
(1) Physiotherapy Department, Prince of Wales Hospital (2) Department of Orthopaedic and Traumatology, Prince of Wales Hospital (3) The Hong Kong Polytechnic University
Introduction :
Posterior spinal fusion is a major surgery for individuals with severe Adolescent Idiopathic Scoliosis (AIS) which requires hospital stay. The shorter the duration of hospital stay the lower the hospital cost. A prehabilitation out-patient physiotherapy programme which combined onsite training and telecare was developed to maximise the cardiopulmonary function, spinal flexibility, and truncal muscle strength and endurance at preoperative phase for AIS patients who will undergo spinal alignment correction and fusion. This programme also integrated the Physiotherapy Specific Scoliosis Exercise (PSSE) which targeted to optimise the mobility and flexibility of the involved spinal segments and ribcage using the 3-dimensional movement analysis approach, in addition to traditional pre-operative physiotherapy regimen (i.e., chest physiotherapy, simulation of post-operative bed mobility and general limb mobilization exercise).
Objectives :
To investigate the feasibility and effectiveness of an 6-week structured prehabilitation physiotherapy programme named as “Enhanced Recovery After Surgery (ERAS)” on the cardiopulmonary function, spinal flexibility, and truncal muscle strength and endurance of patients with severe AIS prior to their planned spinal surgery.
Methodology :
This was a cohort study with pre-and-post-programme evaluations of the list of clinical outcomes encompassing the cardiopulmonary, musculoskeletal and functional capacity for a total of 22 patients with AIS (F:M=13:4, Age: 16.5 ± 3.9, Preoperative Cobb’s angle: 59.9 ± 10.5) who have tentative operation. 17/22 completed the ERAS programme before hospital admission for operation, two of them postponed OT within or after the period and three of them defaulted. Physiotherapy training started eight weeks before operation, with subsequent sessions every two weeks for exercise reinforcement and monitoring. The programme included three onsite sessions and one Telehealth session with patients to physiotherapist ratio of 2:1. PSSE, aerobics exercises, flexibility and strengthening exercises were implemented in the programme. Optimised pain control and early mobilisation were included during the post-operative phase in the programme. For outcome measures, pre-and-post prehabilitation Six-Minute-Walking-Test, McGill’s-Torso-Muscular-Endurance-Test-Battery, Kraus-Weber-Test, Back-Saver-Sit-and-Reach-Test, Popliteal-angle, Pulmonary-Function-Test, Skeletal-Muscle-Mass and Body-Fat-Mass were compared. Post-operation length of stay (LOS) after implementation of ERAS was compared with 17 AIS patients who underwent spinal surgery within November 2022 to April 2023.
Result & Outcome :
The mean value of all the outcome measures had improvement, while there are significant pre-to-post prehabilitation improvements in muscles endurance of bilateral truncal side flexors (Right side: from 38.94s to 56.24s, p=0.001; Left side: from 35.71s to 50.82s, p=0.004), and extensors (from 72.94s to 99.65s, p=0.004) and sit and reach (Right side: from 29.32cm to 31.76cm, p=0.002), Left side: from 29.29cm to 30.76cm, p=0.044). LOS after operation significantly reduced from 9.12 to 6.06 days (p < 0.001). The newly implemented hybrid of tele and onsite prehabilitation outpatient physiotherapy program combining PSSE, aerobic, flexibility and strengthening exercises, together with early mobilization and optimal pain control showed benefits in improving patients’ preoperative muscles endurance and flexibility, and it shortened their postoperative length of stay. Larger sample size is needed for better statistical power for investigation of the effect of the current program. Further investigation is needed for the relationship between preoperative improvements and postoperative outcome.
