Table 3 Barriers and facilitators to our prehabilitation service
Barriers | Facilitators |
|---|---|
Patient selection | Lung function testing at initial outpatient appointment for all patients |
Assessing demand | Piloted via standard PR before setting up bespoke oncology physiotherapy led service |
Evidence base for elements of the programme | Based upon standard COPD optimisation (PR, smoking cessation and optimised inhaled therapy) |
Funding | Utilised pre-existing resources (PR, oncology outpatient physiotherapy and smoking cessation clinic) |
Duration of programme | Referrals made as early in the patient pathway as possible, with a target duration of at least 2 weeks |
Choice of exercise programme | Mixture of aerobic and resistance exercises to moderate intensity, based upon standard PR |
Accessibility | Telephone follow-up and/or local PR referral offered for those with difficulty attending. Use of a smart phone-based app proposed for future expansion. |
Choice of outcome measures | Validated functional measures, 6-min walk test and 5 times sit to stand. Physiological tests FEV1 and DLCO; insufficient capacity to undertake pre- and post-pre-hab CPET testing. Quality of life measure with validated cost-effectiveness component EQ-5D-5 L. |
Patient engagement | Service promoted by both chest physicians and thoracic surgeons with physiotherapist led telephone follow-up for non-attenders. Physiotherapy appointments scheduled to coincide with other appointments such as scans Telephone follow-up offered to enhance engagement. |