Preoperative Rehabilitation: Fit for Surgery

Interview with Associate Prof. Wilhelm Bloch, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne

10/24/2016

Preoperative rehabilitation is gaining importance in medicine. It helps to prepare patients for upcoming treatments and surgeries, thereby reducing risks and complications during surgery and making faster rehabilitation possible.

Image: Wilhelm Bloch; Copyright: Wilhelm Bloch/DSHS Köln

Associate Prof. Wilhelm Bloch, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne; © Wilhelm Bloch/DSHS Köln

Prof. Bloch, what does preoperative rehabilitation mean?

Prof. Wilhelm Bloch: Preoperative rehabilitation ultimately refers to preoperative training to prepare patients for scheduled treatments and interventions.

When is preoperative rehabilitation used and who is involved?

Bloch: Preoperative rehabilitation makes sense for patients who are already restricted due to their underlying primary disease and are generally in a poor state of health or fitness. It is predominantly used prior to surgeries and aims at improving the patient’s initial state. In the orthopedic sector, for instance, the goal might be to work on joint mobility, so the patient is able to become active again much quicker after the surgery. In contrast, the goal of internal medicine predominantly lies in improving the patient’s general state of health with the help of preoperative rehabilitation, so he or she is able to go into the surgery in a relatively fit and healthy state.

Having said that, preoperative rehabilitation can also be applied prior to other treatments such as chemotherapy for example; however this is currently a rare event. That said, its application will continue to gradually move in this direction.

How much time does it require?

Bloch: There is no specific timeframe. It ultimately depends on how long you are able to wait before the intervention or treatment. In the case of a scheduled orthopedic intervention for example, empirically there is adequate lead time, whereas cancer patients only have a limited amount of time. In these cases, you need to decide what is more beneficial: to wait or to immediately perform the surgery. In other words, it always depends on the individual case. Generally, however, you can say that the preparation time takes about four weeks on average.

To what extent does preoperative rehabilitation improve treatment success?

Bloch: Preoperative rehabilitation can reduce risks and complications during surgery. Generally, patients who are more fit are also better in getting through a surgical intervention and the overall treatment. If a patient is expected to have joint surgery for example and exhibits poor mobility, it makes sense to work on this issue prior to the intervention. After all, after the surgery, meaning after receiving a joint replacement, an improvement in mobility beyond the initial situation is rarely possible. That’s why it is definitely important to already take measures before the surgery to be able to achieve greater success.

Image: Woman lying along on a couch. Her right leg is moved by a man standing next to her; Copyright: Panthermedia.net/Wavebreakmedia

To optimize the joint's radius of movement even before a joint surgery, is important in order to achieve greater success; © Panthermedia.net/Wavebreakmedia

Bloch: The entire spectrum of physical therapy, its various approaches, and sports therapy are integral parts of preoperative rehabilitation.

How does preoperative rehabilitation promote rehabilitation?

Bloch: Preoperative rehabilitation and postoperative rehabilitation are two consecutive links: a patient who is already getting in better shape before surgery is generally also able to get through it easier and can be challenged in rehabilitation much sooner. In other words, the patient can overall be "rehabilitated" better and much faster.

Does the time and effort of preoperative rehabilitation pay off financially as well as medically?

Bloch: I am certain that preoperative rehabilitation definitely makes sense. Surgical success can be achieved, risks reduced and complications during surgery avoided with very little effort. And even if it is only effective in a small percentage of cases, it definitely pays off. There is no doubt in my mind about that.

What status does preoperative rehabilitation have in today’s research and application?

Bloch: Preoperative rehabilitation enjoys an increasing status. Having said that, we can still tap further into its full potential if we apply it more consistently and incorporate it systematically into medicine. In my opinion, preoperative rehabilitation is something we simply need to increasingly consider in the future.

The interview was conducted by Nicole Kaufmann and translated from German by Elena O'Meara.
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