Grant: Project Grant - PA: Patient-Oriented Research - Implementation Science

More than 1,000,000 Canadians have surgery each year. While most have good outcomes, more than 1 in 5 have complications and/or develop troubles with day-to-day activities after surgery. Patients and their clinicians have asked that new ways to prepare patients for surgery be developed to help patients avoid these poor outcomes. Because surgery causes stress on the body like that caused by hard exercise (like running a long distance), many believe that training before surgery by doing exercises and eating healthy food could lead to better outcomes. This type of training before surgery is called 'prehabilitation'. Our team, which includes patients, scientists, doctors, nurses, nutrition and exercise experts, and health system leaders, has reviewed the available science on prehabilitation. We've found that prehabilitation may: 1) lead to fewer complications, 2) help patients have better recovery, and 3) may lead to shorter stays in hospital. Unfortunately, the studies that have been done do not line up with how prehabilitation would be done in the real world. This means that we don't know if prehabilitation will work for most patients in regular settings, despite the promise shown in specialized studies. With the experience of COVID-19, we've learned that programs like prehabilitation need to be provided in a way that can be done at home with technological support. In fact, at-home prehabilitation with virtual coaching is likely the most realistic way to allow Canadian surgical patients to do prehabilitation. Virtually-supported prehabilitation has not been widely studied, but needs to be. The next step is to test whether at home, virtually supported prehabilitation, provided in the way that will be used in the real world, will help patients have better outcomes after surgery. Our team has shown that this approach is feasible and practical. Now, we will do a large study across Canadian hospitals to find out if this approach to prehabilitation can help patients.