The US Department of Veterans Affairs Office of Rehabilitation Research & Development has awarded Atilio Barbeito, MD, MPH, a $185,364 I21 grant for his project titled, “Prehabilitation of Veterans with Exercise and Nutrition (PREVENT).” Barbeito holds dual appointments at Duke Anesthesiology (chief of the VA Anesthesiology Service Division) and the Durham VA Medical Center.
Approximately half-a-million operations are performed each year in VA hospitals across the country. Veterans undergoing high-risk surgery have high rates of complications and frequently require readmission to the hospital following surgery. Prehabilitation takes advantage of the weeks leading up to surgery in order to improve fitness, mobility and nutrition in preparation for the upcoming surgical stress. Prehabilitation has been shown to improve fitness, reduce complications and improve quality of life in high-risk surgical patients.
This study aims to determine the feasibility (acceptance rates), acceptability (compliance rates), safety (number of adverse events), and effect size estimates (measure changes in fitness, nutritional state, anxiety and depression, and health-related quality of life) for outcomes of interest of a 3-4 week multimodal prehabilitation intervention that is supervised, individualized, and offered at home via telehealth.
The PREVENT study will allow Barbeito (principal investigator) and his team of co-investigators to test an intervention that combines the fundamentals of physical medicine and rehabilitation with state-of-the-art nutritional support and innovations in care, such as telehealth and the use of activity trackers, to optimize patients before high-risk surgery. This intervention has the potential to not only reduce complications and hospital readmissions, but also to maximize functional recovery and quality of life for thousands of veterans undergoing high-risk surgery every year. It is also the first step in the design and implementation of prehabilitative services for veterans living in rural areas and those with inadequate support or transportation.
“The best prehabilitation programs are multimodal, combining exercise and nutritional support, and deliver moderate to high intensity exercise. In-person exercise programs are optimal because they are typically supervised and can achieve higher intensity, but we know this can be inconvenient for patients without access to transportation or for those who live in rural areas,” says Barbeito, associate professor of anesthesiology. “Our study combines several innovations in the delivery of exercise and nutrition, such as at-home delivery with supervision and automated text messaging and applies them to the perioperative high-risk population for the first time. In addition to departmental and VA support, we are fortunate to be able to collaborate with investigators from Physical Medicine & Rehabilitation, Surgery, Geriatrics, and Nutrition, and have an energetic and experienced exercise physiologist on our team.”