Preoperative physiotherapy (FS-13)

Focused symposium

Reeve J1Boden I2Fiore Jr JF3Valkenet K4 
1AUT University, School of Clinical Sciences, Auckland, New Zealand, 2Launceston General Hospital, Department of Physiotherapy, Launceston, Australia, 3McGill University, Department of Surgery, Montreal, Canada, 4University Medical Center Utrecht, Department of Rehabilitation, Utrecht, Netherlands

Learning objective 1: To appraise the evidence relating to the provision of preoperative physiotherapy interventions for patients undergoing major visceral surgery
Learning objective 2: To evaluate the efficacy of a variety of preoperative physiotherapy interventions for patients undergoing major visceral surgery
Learning objective 3: To make recommendations for clinical practice and further research in the preoperative physiotherapy management of patients undergoing major visceral surgery
Description: Over 230 million people worldwide undergo major surgical procedures each year (Neto et al., 2014). Advances in anaesthesia, surgical techniques and perioperative care have improved surgical outcomes and reduced length of hospital stay but concomitantly increased the number of higher risk patients eligible to undergo major surgery. Consequently, postoperative complications still occur in up to 40% of patients and remain a target for quality care improvement (Canet et al., 2010).
In patients undergoing major visceral surgery, physiotherapy interventions have been widely utilised since the 1950's (Reeve & Boden, 2016). Such interventions aim to improve surgical outcomes by preventing and treating postoperative complications, primarily pulmonary, vascular and musculoskeletal complications. Previously, physiotherapy interventions largely consisted of interventions applied postoperatively, however, with an increasing global focus on preventative rather than curative health care, there has been growing interest in providing and evaluating physiotherapy interventions before surgery, especially patient education and preoperative exercise training (prehabilitation) (Boden et al., 2018, Mans et al., 2014, Valkenet et al., 2011). These interventions aim to improve patient physical and psychological status prior to the surgical procedure by means of exercise training to improve functional capacity to assist in the reduction of postoperative complications, and education to improve knowledge of the postoperative rehabilitation required to return patients to their desired level of function. Recent evidence from randomized controlled trials, systematic reviews and meta analyses suggests that preoperative physiotherapy interventions help preparing patients for surgery, increase functional capacity and reduce the risk of postoperative complications (Boden et al., 2018, Moran et al., 2016, Hijazi et al., 2017, Barberan-Garcia et al., 2018).
This symposium will provide an overview of the evidence to date regarding preoperative physiotherapy interventions for patients undergoing major abdominal, thoracic and cardiac surgery, drawing conclusions where possible about the efficacy of these interventions and making recommendations for clinical practice and further research. Additionally, we will consider the economic implications associated with preoperative physiotherapy interventions.
Implications / Conclusions: The increase in high quality evidence available regarding the preoperative physiotherapy management of patients undergoing major visceral surgery gives physiotherapists attending this symposium the opportunity to review the latest available evidence from clinical and research experts in the area. It will offer attendees the ability to discuss the clinical implications of this research in relation to their practice and recognise where alterations in their practice and service provision may be required to best improve patient outcomes. Aspects of physiotherapy management that require further research will be highlighted. This symposium will also offer attendees the opportunity to meet with like-minded physiotherapists to form research, networking and support opportunities. 
Key-words: 1. Major surgery 2. Preoperative 3. Physiotherapy
Funding acknowledgements: Not applicable
Relevance to physical therapy globally: Internationally, physiotherapists are widely involved in the management of patients undergoing major visceral surgery. Recent evidence suggests that implementing physiotherapy interventions in the preoperative period may assist in improving surgical outcomes. This symposium provides physiotherapists from around the world the opportunity to develop their knowledge and understanding of the current evidence relating to preoperative physiotherapy, and to engage and share ideas with contemporary researchers and clinicians conducting studies in this area.
Target audience: Physiotherapy clinicians working with patients undergoing major visceral surgery; physiotherapy researchers and educators.