Optimising surgical outcomes: evaluating the efficacy of a co-designed prehabilitation program at West Moreton Health - Phase 3

Phase 3 (Intervention - Yet to Begin Recruitment): PLEASE NOTE - this is not an RCT (with the main outcome of this study being feasibility of implementation). There is no allocation beyond recruitment. Participants in this Part/Phase 3 will be allocated to all intervention arms allowed for by time and consent. Participants will be allocated to receive 1, 2, 3 or all 4 arms of the intervention depending upon when they choose to enrol in the study relative to their scheduled surgery. Participants who choose to enrol 4 or more weeks prior to their surgery will receive all 4 arms, participants who choose to enrol 2-3 weeks prior to their surgery will receive arms 1-3. PREHABILITATION Arm 1: Physiotherapy Led Education - Priority 1 (If recruited <1 week from surgery) - 30 Minutes Face to Face Education with a Physiotherapist regarding Respiratory Function, Mucociliary Clearance, and self directed breathing exercises to complete post operatively (2 sets of 10 deep breaths with 5 second inspiratory hold, with 3x coughs or huffs with supported bracing, every hour while awake).. Created handout/brochure educational materials also provided (currently pending approval) to provide alongside. - Delivered <1/52 from scheduled surgery Arm 2: Dietitian Led Education - Priority 2 (Delivered <2/52 from scheduled surgery) - Face to Face OR Telehealth 30 minute dietitian consult conducted within existing dietitian outpatient clinical service. Dietitian will conduct a Subjective Global Assessment to determine nutritional status. Participants identified as malnourished or at risk of malnutrition will be provided high protein, high energy education and patient resources from NEMO (nutrition education material online). These nutrition education materials are designed for members of the public and provide nutritional information targeted at Grade 7 English levels. Participants who are malnourished may also be prescribed high protein, high energy drinks if clinically appropriately. Depending on the surgery, participants may be upgraded on diet progression post-surgery e.g. Clear fluid diet, free fluid diet and low fibre diet. These resources are available on NEMO. This will be based on participant situation. For participants who are well nourished at baseline and not identified as nutritional risk they will be provided this material. They will also be directed to watch the Nutrition before surgery video developed by Queensland health dietitian. Video - Nutrition Before Surgery (https://vimeo.com/709278790) Arm 3: Inspiratory Muscle Training (IMT) - Priority 3 (if recruited 2-3/52 prior to Scheduled Surgery) - 30 Minute Face to face physiotherapy led motivational interview, education, free provision of IMT device (POWERBreathe Medic Plus) and individualised prescription (targeting 50% of Max Inspiratory Pressure, 2x30 reps daily until surgery), and progressive walking program prescription (intensity recommendations inline with Australian Governments Physical Activity and exercise guidelines for all Australians - participants self assessing exercise intensity with education - goal of 30 minutes moderate intensity exercise daily until surgery). Arm 4: Group Cardiovascular Exercise - Priority 4 (if recruited 4/52 prior to scheduled surgery) - Face to Face, biweekly, 1 hour long, supervised individualised group exercise classes provided by university student led exercise physiology clinic, for 4 weeks prior to surgery - intensity and specific exercises as prescribed by student exercise physiologists under Accredited Exercise Physiologist supervision, with referral and exercise clearance being provided by Trial Medical Officer. Participants will not be specifically directed to complete additional exercises at home as a part of the intervention. adherence to all arms will be monitored by session attendance and participant feedback using an 'Adherance Log' form each participant will complete. participant input and feedback will be sought through semi structured interviews reflecting on their hospital recovery following their surgery, comparing with historical control data prior to intervention. This will inform the basis of codesign for full implementation / feasibility of a future model (noting that a large component of historical data collection for codesign was investigating participants desire for PT/dietitian input as well as face to face vs telehealth data).