Stanford Medicine's Success With SeamlessMD For Prehab Featured on Stanmed
March 16, 2020
Implementing proven patient prehab protocols, such as daily walks before surgery, can improve outcomes related to patient experience and quality of life post-operatively.
However, new protocols present new challenges such as patient compliance.
For example, how do we ensure patients know what to do, when to do it, and how to do it?
And how can we as providers track patient compliance, measure the impact of our protocols, and effectively support patients falling off-track?
To solve these challenges and implement a prehab module to support patients via reminders, education, compliance tracking, and automated feedback, Stanford Medicine turned to SeamlessMD.
The following is an excerpt by Jonathan Wosen from the Stanmed blog. The original link can be found here:
Training for the big race
Many doctors, including Cindy Kin, MD, assistant professor of surgery, compare the stress surgery places on the body to running a marathon. Running for hours and lying on an operating table might seem like polar opposites, but general anesthesia stresses the heart, and even having minor surgery can be exhausting.
That got Kin thinking — if you wouldn’t run a marathon without training, why would you have surgery without preparing?
Kin’s patients often asked her what they should do before surgery, but the standard answers she’d been trained to provide were vague — eat healthy, stay active, keep doing what you’re doing.
“Patients are looking for something to do before surgery because they’re nervous, fearful and vulnerable,” Kin said.
So, to come up with better answers, she launched a study on prehabilitation, or “prehab.”
In a 2014 pilot study, Kin enrolled 40 patients who were slated to have abdominal surgery — including removal of sections of their intestine because of cancer or inflammatory bowel disease.
Twenty of the patients were told to walk 5,000 steps a day and to perform strengthening exercises in the weeks before surgery. The same patients also downloaded a mindfulness meditation app and were counseled to eat a diet rich in whole foods and low-fat proteins. Patients in the control group were given no specific instructions.
Four weeks after surgery, an analysis of pain outcomes showed that prehab patients’ self-reported pain was one point lower on a 10-point scale than that of control group patients — an encouraging sign.
In a follow-up study from 2018 to 2019, Kin enrolled 250 colorectal surgery patients — including Notar — and instructed them to use SeamlessMD, an app that sent them information about the Mediterranean diet; it also reminded them to walk at least 5,000 steps a day and perform core-strengthening exercises three times a week.
Notar incorporated the exercises into an already busy schedule by waking up at 3:30 a.m. instead of 5 a.m. so she could squeeze in some of the exercises. And when she got home around 6 p.m., she’d prep dinner and finish the remaining exercises while her food cooked.
It was a grueling routine, but she lost 8 pounds during six weeks of prehab and felt stronger and more energetic. She was also much more relaxed about her upcoming surgery.
It turned out that Notar would need every ounce of her newfound strength to recover from the January 2019 surgery. Her surgeon had to remove more of her colon than was expected and, during the operation, Notar’s spleen started bleeding and had to be removed.
By the time Notar was well enough to return home, she had lost about 30 pounds. Still, she credits prehab for her ability to return home at all.
Overall, prehab seemed to pay off for other patients in the trial, too. After surgery, they used half the amount of opioids per day spent in the hospital than a group of 250 surgical patients who did not have prehab, though various medical and demographic factors also could have played a role, Kin said.
“I don’t think I’d be here if I hadn’t done the prehab,” said Notar. “The recovery was really tough, and if I had not built up that extra strength I don’t think I would have made it.”
A member of Kin’s research team presented these findings at a meeting of the American College of Surgeons in October. Kin and another Stanford surgeon, Brendan Visser, are planning a new app-based prehab study in which patients use wearable fitness trackers to monitor their heart rates, sleep patterns and activity levels. Patients will perform exercises that prepare for the first step of their recovery — getting out of bed. The researchers will track whether prehab reduces postoperative pain, narcotic use and infection rates.
Such prehab programs are in place at some health care centers, including at McGill University in Quebec, Canada, but are not widespread. Kin hopes her research will expand the scope of prehab and empower more patients to make concrete, evidence-based lifestyle adjustments that improve recovery.
“If your doctor suggests that you do prehab, do it,” Notar said. “If your doctor doesn’t suggest it, ask them about it.”
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