Is Prehab Therapy the Key to Unlocking Better Post-Surgery Outcomes?

From low back and knee pain to surgical rehab, musculoskeletal (MSK) conditions are common, widespread, and on the rise. Approximately 1.71 billion people worldwide are currently living with MSK conditions—a number that has been rapidly increasing due to population growth and aging demographics.¹ In the U.S., 1 in 2 adults report an MSK condition each year.² On top of that, MSK disorders are expensive to treat, costing the U.S. healthcare system a grand total of over $380 billion—more than any other category of care.³ 

The need for timely, high-quality, and cost-effective MSK care is very real, but the good news is that there is a rehabilitation strategy that can help combat the high costs of MSK care while boosting surgical outcomes—prehabilitation. And to maximize this strategy, prehabilitation can be integrated with digitally-enabled care options like personalized home exercise programs (HEP), targeted education, or a robust digital MSK care platform to guide patients through a digital or hybrid care model.

What Is Prehabilitation?

Prehabilitation, also commonly known as prehab, is participation in therapy-based exercises to avoid injury, decrease pain, or to prepare for a surgery. When it comes to prehab, there are generally two approaches: preventative prehab, which is the process of taking preventative measures to reduce your chance of injury, and surgical prehab.

Surgical prehab is used before a surgical procedure to prepare the body for surgery and strengthen supportive structures around the affected area. The purpose is to put the individual in the best position for a successful surgery and experience good outcomes during their post-surgical rehab process. 

What Are the Benefits of Surgical Prehab?

Benefits for Healthcare Providers

Prehabilitation is an underutilized resource that helps patients have a better surgical experience. Most elective surgeries in the US require months between scheduling and the day of surgery, leaving time for a comprehensive prehab program. However, in the current overburdened MSK care landscape, it can still be hard to find room in schedules for patients to receive pre-op care—and that’s where hybrid care comes in.

Hybrid care platforms, like MedBridge Pathways, make it easier for organizations to create robust prehab programs for their patients to improve surgical outcomes and patient satisfaction. Musculoskeletal prehab helps patients prepare and strengthen their bodies for the surgical process, helping them ease into their rehab assignment more seamlessly, reduce pain, and improve overall recovery. One study found that “patients who completed exercise-based prehabilitation before their operation showed significant postoperative improvements compared with no intervention.”⁴

Hybrid prehab is also highly effective for increasing patient engagement while treating MSK injuries at a reduced cost. In fact, patients who received virtual MSK care after knee replacement reported similar outcomes and satisfaction compared with patients who received traditional in-person care at 60 percent lower utilization of resources.⁵

Benefits for patients

Prehab has many physical benefits for patients. Hybrid prehab programs can help stabilize pain levels before surgery, get patients prepared for post-surgical physical challenges, and get them back on their feet faster after their procedure. For example, with patients undergoing total hip arthroplasty, significant improvements were observed for pain, function, and length of stay.⁶ But there are also benefits that help them prepare for their journey to recovery, such as learning how to use a walker or crutches before surgery (so that they’re not learning how to use them while actively recovering), making home modifications, or setting expectations for post-op pain and discomfort so the patient is not caught off guard.

There are also additional benefits from a psychological standpoint. Prehab gives the patient the opportunity to learn about what the surgery recovery process looks like before undergoing the procedure. Research shows that patients who are better educated about what to expect with pain intensity and typical post-op recovery timelines in regards to returning to daily activities like walking independently, showering, or driving show better post-op outcomes and better satisfaction. In one multi-center randomized clinical trial, half of the patients preparing for lumbar surgery received preoperative pain neuroscience education (PNE) and the other half did not.⁷ Patients then underwent lumbar surgery and were tracked for three years post-op.⁸ At one year after lumbar surgery, there was no difference between the two groups for back pain, leg pain, and disability—however, the PNE group, despite having similar pain and disability, rated their surgical experience far superior, including willingness to undergo another surgery, and rated the surgical experience as positive, versus the non-PNE patients.

What Challenges Do Providers Face While Adopting Prehab Programs?

If prehab is so effective, why aren’t more providers offering it? There are several barriers to effective prehab that affect both providers and patients. First of all, many patients don’t even know that prehab exists! Then there’s the matter of patient motivation—it can be difficult enough to engage patients with programs meant to address a tangible health issue; it’s another matter to get them to engage with proactive therapy for a surgery that they haven’t received yet.

That’s why as providers, we need to share the benefits of prehab to get them on board and motivated as active participants in their care.

But there are also barriers that prevent providers from utilizing this important care strategy. The current strain on healthcare providers, especially physical and occupational therapists, affects the quality and accessibility of prehab programs. But instead of viewing it as a new type of care program that requires time and effort to initiate, we need to look at it as an opportunity to treat patients along a longer trail of care. The initial investment in proactive therapy in the beginning can make the patient’s post-surgical journey go much more smoothly. And if they have a good experience pre-op, they’re most likely to come back post-op and finish their care because you’ve established a good relationship with them.

How to Leverage Hybrid MSK Care to Maximize Prehab

MedBridge Pathways is our new provider-first digital MSK care platform, purpose-built to keep therapy at the forefront of care and help organizations deliver superior patient outcomes across the musculoskeletal care spectrum. It’s a game changer for prehab programs, allowing for flexible hybrid care that can evolve alongside a surgical patient’s entire care journey.

By supplementing existing in-person programs with a variety of digital care pathways based on patient acuity, Pathways engages patients with therapy-driven care that incorporates their condition and lifestyle, and delivers that valuable data back into the clinician’s hands so they can leverage their expertise. Programs are personalized through an onboarding questionnaire that takes into account each patient’s pain, goals, and activity levels. 

For a patient undergoing a prehab program, Pathways can help guide them through this stage of the process while they prepare for their surgical procedure. Then as their therapy needs change post-surgery, Pathways can help supplement in-person care and pivot alongside the changing needs a patient might encounter during their rehab journey.

Conclusion

By 2030, every member of the baby boomer generation—nearly 73 million Americans—will be eligible for Medicare, and with them will come a corresponding rise in MSK treatments and surgeries. Prehabilitation and hybrid care will become vital tools to take on this challenge and ease the burden on our already overwhelmed healthcare system. 

By utilizing hybrid care, we can help provide more interaction between the care team and the patient when they are outside the clinic, so clinicians can maximize the time they get in person with their patients. This helps providers gain more frequent touchpoints that help promote consistent patient engagement and activation, and improve continuity of care from prehab to post-op rehab.

MedBridge Pathways won’t disrupt the clinician-patient relationship; instead, it empowers providers to keep patients in their ecosystem for a lifetime of care. With Pathways, providers can supplement brick-and-mortar care with a cutting-edge, digitally-enabled therapy platform that gives patients a modern and convenient care experience, improves health outcomes, and allows higher care capacity while reducing the provider workload and lowering costs. And together, we can help millions of people with MSK conditions to move better, feel better, and live better.