Before any elective surgery, physicians try to prepare patients and reduce complication rates by stabilizing any known medical issues. Growing research also points to the value of considering other health indicators, such as mental health, substance use, chronic pain, nutrition, and physical activity, prior to a patient’s surgery. Improvements in these areas can make a significant difference to how quickly a patient recovers from surgery and is able to resume their usual activities.
Through conversations with Dr. Duncan Jacks (Orthopedics), Dr. Karen Johnsson was inspired to bring together a multidisciplinary group of physicians to explore this topic. Seeking a grant from the South Island MSA, the group aimed to gather insights from clinicians and allied health. Discussions included Dr. Jacks and Dr. Sonja Mathes from Orthopedics, Dr. Mark Vu from Anesthesia, and Drs. Mark Sherman, Trish Snozyk, Lauren Dake, and Stu Gershman from Family Practice. Allied health team members included RN Paula Sanglap-Bono, psychologist Dr. Bruce Pinel, and physiotherapist Gillian Hurst. Island Health administrators helped to organize the process. Early collaboration investigated the broader facets of pre-surgical optimization for arthroplasty patients and ultimately led to the development of a group patient education course to promote patients’ presurgical resilience with a focus on improving mental health, pain, and lifestyle. This course was called PROP, the Presurgical Resilience Optimization Project.
The group met over the course of a year to brainstorm ideas, review current research, debate content, and generate ideas about how to present the program and engage patients and physicians. The final product, a 4-week virtual group session, taught techniques in mindfulness meditation, cognitive therapy, and pain neuroscience to address pre-surgical anxiety, depression, persistent pain, and healthy sleep. This group was piloted in late 2020 and was well received. One patient commented: “The content was very good, and I really do feel like I have a toolkit to help me with my next surgery”.
Near the end of this project, the group received concurrent support through the Specialist Services Committee’s Surgical Patient Optimization Collaborative (SPOC) program to further develop the PROP content into an 8-week course. This allowed expanded discussions on pain, and inclusion of education around nutrition, physical activity, and social supports. Initial patient feedback continues to be extremely positive, with patients reporting that they felt better prepared for surgery, and would recommend the course to others.
Speaking about the value of the funding, Dr. Johnsson commented: “SIFEI support was invaluable to getting started on a large project that would otherwise never have happened. Having funding to support interdisciplinary discussion was critical. It was a lot of work, and a labour of love, but having funding made it possible”.
The group is interested in expanding their program to include other types of pre-surgical patients and is open to referrals from colleagues outside of Orthopedic surgery. If interested, please get in touch with the team through prop@rebalancemd.com .