“Prehab”

This new nickname it popping up all around the internet and amongst friends and family. Truly though, it’s nothing new in the physical therapy community. I know in my years as a therapist, we have always preached that the stronger, more flexible, and healthier you are either before an injury or surgery, the faster you will recover. In my experience, I have seen many orthopedic surgeons getting on board with this. I’ve had surgeons specifically request therapy care to not only address musculoskeletal issues, but educational pieces for their patients as well. We can help assist patients in counseling them on what to expect, precautions, as well as how to improve safety around the home specifically for post operative care. It looks like all of this “prehab” is being further researched and it could save some insurance companies, as well as patients, some money and time. Luckily for us therapists, and even more so for our patients, the theory of improved health, specifically joint health and pre operatively, leading to better outcomes is proving to be so very right!
Prehabilitation, or prehab, is the term coined for physical therapy before an elective surgery. Injuries or wear and tear can cause an increase in swelling, decrease your balance, decrease your strength, and your range of motion. Physical therapy can help improve all of these things, and the better these are before surgery, the better, and faster you’ll recover after an operation. If you’re very, very weak before surgery, the path to increasing strength post operatively can be painstakingly slow. If we can improve that strength for a few session before surgery, your starting point for strength will be MUCH higher and getting enough strength to walk or perform stairs will be that much easier! If the issue is swelling, physical therapy can use both modalities, and patient education to assist in decreasing this before surgery as well. The possibilities of how we can help you are endless, and it’s up to each individual therapist to perform an evaluation and see exactly what each person needs in regards to care.
It looks like most research is being done towards physical therapy before elective joint surgeries. This is a great start, as these surgeries are becoming more and more popular as their success rates rise and we continue to live longer and more actively, meaning our joints are needing a little more help! The most recent study I’ve seen is in the Journal of Bone and Joint Surgery, October 2014 Issue. This study has gone on to show that pre operative therapy before a total hip and total knee replacement can actually decrease the cost of post operative care by 30%. It also showed that about 55% of those who received preoperative therapy needed post acute care services, versus almost 80% of those who didn’t receive pre operative therapy needing post acute care services. Post acute care in this study is defined as skilled nursing facilities, home health agencies, or inpatient rehabilitation facilities. These are known to be expensive forms of care in the physical therapy and Medicare world. The pre operative therapy in this study was typically limited to 1-2 sessions.
Hopefully we continue to gather more information about the benefit of physical therapy before surgeries. It’s looking like it will not only benefit the patient, but the insurance company and payers as well. Take this information home with you and use your new knowledge at your next doctor’s appointment. If you or a loved one are planning on an elective joint surgery soon, talk to your doctor about the possibility of some physical therapy before the surgery date. It’s looking like it is what’s best for everyone!