Application Of Trimodal Prehabilitation Strategy In Patients With Gynecological Oncology Surgery

ObjectiveTo investigate the application strategy for preoperative trimodal prehabilitation on patients with gynecological oncology;to estimate the effect of trimodal prehabilitation strategy on perioperative and prognostic physiological function and psychological state of patients with gynecological oncology;and to provide new ideas and methods for preoperative trimodal prehabilitation on patients with gynecological oncology.Methods1.By using the convenience sampling method,100 patients with gynecological malignant tumors,who visited a tertiary A-level hospital in Dalian City,and intended to receive operation in the hospital,were selected as the research objects.Then by using the non-contemporary comparison method,50 of the patients admitted to the hospital from January 2021 to May 2021 were set as the control group,and the rest 50 patients who were treated in the hospital from June 2021 to October 2021 were set as the experimental group.2.The control group received routine enhanced recovery guidance,including preoperative,postoperative and discharge guidance during the perioperative period.On this basis,the experimental group set up a trimodal prehabilitation group and on the basis of theoretical guidance and literature reference,designed the intervention scheme of the experimental group initially.Relevant experts were invited to improve the intervention scheme through group discussion and brainstorming,and finally the formal experimental intervention scheme was further adjusted through the pre-experiment.The program includes physical exercise,respiratory exercise and pelvic floor muscle exercise,nutrition optimization and psychological support.The duration of intervention was about 1 week from the day of admission to the day before surgery,and the follow-up time was from the day of admission to 30 days after surgery.3.Main effect indicators:The body function status was evaluated by the six-minute walking test(6MWT),they were collected on the day of admission,1 day before surgery and 30 days after surgery.Secondary effect indicators:Mental state was evaluated by Hospital Anxiety Scale(HAS),and overall Health level was evaluated by Rand 12-Item Health Survey v2(SF-12v2).They were collected on the day of admission,1 day before surgery and 30 days after surgery.Short-term postoperative recovery quality was evaluated using the 9-item quality of recovery scoring system(Qo R-9),which was collected on 3 consecutive postoperative days.The first time to move out of bed,the first time to exhaust gas,the length of hospital stay,postoperative complications.SPSS25.0 was used to statistically describe the data;mean±standard deviation,frequency and percentage were used for statistical description;normality test,independent sample t test,paired sample t test,x~2 test,Fisher’s exact test and repeated measurement variance test were used for statistical test.Results1.There was no statistic difference between the experimental group and the control group in age,height,weight,body mass index,disease category,previous history,whether preoperative neoadjuvant chemotherapy was received,preoperative intervention time,6MWT,HAS score,SF-12v2 score and other baseline information(P>0.05).No statistic difference was found between the two groups in operation time and operation mode(P>0.05).2.After the trimodal prehabilitation intervention,the 6MWT in the experimental group was higher than that in the control group one day before the surgery,and increased by 38 m compared with the baseline(P<0.001);the 6MWT in the control group decreased by 14 m compared with the baseline(P<0.001).30 days after the surgery,the 6MWT in the experimental group was higher than that in the control group(P<0.001),the 6MWT in the experimental group and the control group decreased by respectively 14 m(P<0.05)and 81 m(P<0.001)compared with the baseline.3.71.4%of the patients in the experimental group could restore the motor ability to the baseline,and 97.9%of the patients in the control group retrogressed from the baseline.The HAS scores of the experimental group were lower than those of the control group one day before the surgery and 30 days postoperatively(P<0.001).There was no statistic difference in the Physical composite scale(PCS)scores between the groups one day before the surgery(P>0.05),but the scores increased compared with the baseline(P<0.05);the PCS scores 30 days after the surgery were higher than those of the control group(P<0.001).The Mental health composite scale(MCS)scores and SF-12v2 scores of the experimental group were higher than those of the control group(P<0.001)one day before the surgery and 30 days postoperatively.The Qo R-9 scores of the experimental group for 3 consecutive days after surgery were higher than those of the control group(P<0.001).The first postoperative out of bed time and the exhaust time of the experimental group were earlier than those of the control group(P<0.05),and no significant difference was found in the length of hospital stay and postoperative complications between the groups.ConclusionTrimodal prehabilitation strategy can significantly improve the preoperative motor ability of gynecological oncology patients,improve their anxiety,enhance their overall health level,advance their first postoperative out of bed time and exhaust time,restore their intestinal function,accelerate postoperative rehabilitation,and provide new ideas and methods for preoperative nusring of gynecological oncology surgical patients.