What is Prehabilitation?
Evidence shows that improving your physical and mental wellbeing can help you cope with what lies ahead. We call this prehabilitation, or prehab for short
As well as helping you to cope, Prehabilitation can help you to recover more quickly from surgery, and reduce the chance of developing other problems during and after treatment.
This includes advice and support on activity and exercise, diet and nutrition, mental wellbeing, alcohol and smoking. It is also important to look at other needs individuals may have e.g. money advice, home energy costs, cost of food, support in a caring role and social connectedness.
More information to support your health and wellbeing while waiting for an appointment/treatment can be found via NHS Inform – Waiting Well.
Prehabilitation for Scotland
Information for the public and professionals: Prehabilitation for Scotland – This website provides a range of information for both the public and professionals. Although this website talks mainly about cancer, much of this information is relevant to other conditions.
Pre-Operative Assessment
Pre-Operative Assessment – Information and resources on getting ready for surgery, FAQ’s information videos and information on different sites.
Realistic Medicine
Realistic Medicine is about supporting people using healthcare services, and their families, to feel empowered to discuss their treatment. Realistic Medicine also promotes shared decision making and a personalised approach to care which are also values central to Prehab.
Holistic Needs Assessment
Holistic needs assessment (HNA) and care planning was first introduced by the National Cancer Survivorship Programme to help identify the concerns and needs of people living with cancer. The holistic needs assessment and care planning tool provides a useful framework for the basis of a person-centred discussion based on what matters to the person at that time. Used with appropriate training, information and knowledge of available supports to meet needs, the tool facilitates the following:
- Identification of need / impact of wider determinants;
- Self management, self-care;
- Person-led care or goal-setting, health and wellbeing improvement;
- Social-prescribing, mitigating impact of poverty and life circumstances;
- Applied health improvement, developing the wider health improvement workforce, embedding health improvement in clinical care.
In recognition that many of the issues faced by people living with cancer are similar to those for people living with other life changing and/or deteriorating conditions, the Acute Health Improvement Team identified areas where this approach could be tested:
- Parent/Carers within Royal Hospital for Children
- People undergoing lower limb amputation at QEUH
- People attending Physical Disability Rehabilitation Unit at QEUH campus
- People attending for renal dialysis at IRH.
The concerns in the cancer focused tool required review with clinical colleagues to tailor concerns to meet the needs of each of the different groups. A monitoring and evaluation framework for the work was developed to ensure outcomes were captured.
National Cancer Survivorship Initiative. Living with and beyond cancer: taking action to improve outcomes,
Department of Health, 2013
In April 2017 tests of change were developed in adult acute services to determine how the HNA and care planning model works in adult hospital settings beyond cancer services. As a result, three locations were chosen, reflecting patients who were experienced permanent changes to their lives as a result of health conditions or traumatic events:
- Renal Dialysis Unit, Inverclyde Royal Hospital,
- Physically Disabled Rehabilitation Unit (PDRU), Queen Elizabeth University Hospital, Glasgow
- Ward 11A (lower limb amputees), Queen Elizabeth University Hospital, Glasgow
Each location chosen was allocated a member of the health improvement team to liaise with them to facilitate the process in their location. This was in recognition of the fact that the implementation process was likely to be different in each location, reflecting the differing patient groups, nature of clinical interactions, and experience of conducting health behaviour change discussions in each clinical area.
The delivery model for implementing the Supporting People in Hospital approach varied amongst the three locations as follows:
- Nurse led – Renal Dialysis Unit
- Key worker led (both AHP’s and Nursing staff) – PDRU
- Health Improvement Led from Support & Information Service – Ward 11A (and Ward 11D).
The HNA has been rolled out to further to Renal services at the QEUH with other areas planned. Over time, the completion of the tools has been incorporated into routine practice within these areas.
Below is a video clip of Katharine Montgomery, Staff Nurse, Renal Unit IRH talking about how the HNA has been implemented in their area.
An initial evaluation on the HNA was completed in July 2017 and a learning event took place October 2017 where findings were disseminated. The evaluation found that:
The patients welcomed this approach:
- “It’s about helping me if I have anything that is worrying me”
- “It gives me the chance to tell someone if I need help with things at home”.
- “It gave me the chance to talk to my family about how I felt and for them to tell me how they felt too”.
The staff welcomed this approach:
- “Our patients go out of here different to when they come in. They usually come in mobile and leave in a wheelchair. It’s a huge psychological as well as physical change and it affects every part of their lives. Nothing is the same for them anymore and this is a great opportunity for them to talk to someone about more than just their medical condition”
- “Coming in here is a massive part of their weekly lives and they are exhausted. We talk to them about how they feel physically but they have many other issues – particularly money, so this is a really good way of helping them deal with things which are affecting them and their families”
Current projects
Macmillan Prehabilitation project
The West of Scotland Cancer Network (WoSCAN) was awarded funding from Macmillan Cancer Support to recruit Prehab Advocate posts in 4 heath boards to deliver a 14 month prehabilitation project. The health boards are NHS Greater Glasgow & Clyde (NHSGC), NHS Ayrshire & Arran, NHS Lanarkshire and NHS Forth Valley.
In NHSGGC, 2 Prehab Advocates (Health Improvement Seniors) have been recruited and started in June 2024. The Prehab Advocates have started mapping current Prehabilitation provision in cancer services across NHSGGC. They will also coordinate and deliver improvement projects to support wider implementation of Prehabilitation approaches including:
- Clinical pathways: Working across local health systems to use existing screening tools for prehab referrals, and making links with services already in place delivering prehab.
- Education and engagement: To support clinical teams to understand the benefits of prehab and raise awareness of existing prehab services, supported by the WoSCAN regional prehab education programme
- Sharing good practice: Utilising and learning from the models of prehab practice in place within other constituent health boards, with an ambition to copy and embed similar projects in each Board, and increase available prehab offers for patients.
To find out more about this work please contact: Jane Grant, Health Improvement Lead, email: Jane.Grant6@nhs.scot