Excerpt from one of Dr. Fisk’s articles:
“Lifestyle modification is a critical, under-addressed component to pain and functional status optimization. In the perioperative patient, prehabilitation has been demonstrated to improve surgical outcomes and reduce patient frailty scores.[i] While prehabilitation can simply involve general aerobic, flexibility, functional activity, and strength training in order to reduce frailty scores, specific physical therapy designed to improve the area of the body to be operated upon can be important as well. Results in total joint replacement patients have been mixed, with a 2013 meta-analysis demonstrating improved outcomes in total hip but not knee patients. [ii] A 2016 pilot RCT demonstrates improved knee mobility with prehabilitation but this did not translate to improved quality of life or functional mobility based on the metrics evaluated.[iii] It is postulated that poor preoperative exercise tolerance in patients awaiting knee replacement may explain this difference. [iv] A 2014 analysis of pre-operative physical therapy suggests a marked reduction in resource utilization post-operatively in total joint surgical patients who had as few as 1-2 session of physical therapy preoperatively. The reduction in utilization was largely driven by a lesser need for skilled nursing facility and home health agency care.[v]
Exercise generally is important in the management of opioid-dependent patients. Exercise has been demonstrated to help mitigate psychiatric comorbidities such as depression. However, the exercise regimen needs to be adhered to and sufficiently vigorous to achieve the desired physiological and psychological effects. This is especially challenging in opioid dependent patients, or perioperative patients with significant pain, who must cope with severe emotional, physiological, and pain disturbances as they attempt to participate in these rehabilitative activities. As such, structured, prolonged physical therapy, as well as an exercise coach who continues to provide encouragement and accountability for these patients, is yet another crucial component within the multidisciplinary team needed to address pain and functional status optimization. Facilitated, otherwise painful physical therapy by acute pain specialists equipped to help manage specific pain generators with, for example, short term motor sparing nerve catheters, is severely lacking in the outpatient setting.”