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Table 3 Barriers and facilitators to our prehabilitation service

From: Feasibility of setting up a pre-operative optimisation ‘pre-hab’ service for lung cancer surgery in the UK

BarriersFacilitators
Patient selectionLung function testing at initial outpatient appointment for all patients
Assessing demandPiloted via standard PR before setting up bespoke oncology physiotherapy led service
Evidence base for elements of the programmeBased upon standard COPD optimisation (PR, smoking cessation and optimised inhaled therapy)
FundingUtilised pre-existing resources (PR, oncology outpatient physiotherapy and smoking cessation clinic)
Duration of programmeReferrals made as early in the patient pathway as possible, with a target duration of at least 2 weeks
Choice of exercise programmeMixture of aerobic and resistance exercises to moderate intensity, based upon standard PR
AccessibilityTelephone 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 measuresValidated 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 engagementService 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.
  1. CPET cardiopulmonary exercise test, DLCO transfer coefficient for carbon monoxide, EQ-5D-5 L EuroQol five dimension five level, FEV1 forced expiratory volume in 1 s, PR pulmonary rehabilitation