Taking physical rehabilitation after abdominal cancer surgery further : by enhanced recovery and physical activity

The overall aim with this thesis was to increase knowledge of standardised methods for individualised mobilisation and rehabilitation after abdominal cancer surgery. Concerning mobilisation, both effect, and patients’ experiences of a method for postoperative mobilisation were evaluated, as well as the association between early mobilisation (daily steps) and complications. For rehabilitation, the feasibility of an exercise programme in primary care was evaluated.

This thesis includes four studies with four different designs: a nonrandomised controlled trial (study I), an observational study based on a secondary analysis of study I (study II), a qualitative interview study (study III), and a feasibility study (IV). The patients in the studies were recruited at Karolinska University Hospital before elective abdominal cancer surgery. The patients included in study I, and II (n = 133), and III (n = 15) were diagnosed with ovarian, colon, rectum, or urinary bladder cancer, while in study IV (n = 10) all the patients were diagnosed with urinary bladder cancer.

In study I, the effect of using the Activity Board as a standardised method to enhance mobilisation and postoperative recovery was evaluated. The Activity Board hangs in the patient’s room with signs for different individually based exercises, and red/green magnets for the patient to turn when a goal is achieved. The level of mobilisation was objectively measured with an activity monitor. The results showed significantly higher levels of mobilisation as a mean level over the first three postoperative days, as well as a shorter time to first flatus and stool, and shorter length of hospital stay, compared to standard treatment.

In study II, the association between early mobilisation (daily steps) and readmission, the severity of postoperative complications, and infectious complications was respectively evaluated. No significant association was seen between early mobilisation and any of the outcomes.

In study III, patients’ experiences of using the Activity Board after abdominal cancer surgery was described. Individual interviews were conducted, and the overarching theme that emerged from the content analysis was “enabling participation facilitates empowerment over rehabilitation”.

In study IV, the feasibility of an exercise intervention for patients who had undergone a robotic-assisted radical cystectomy was evaluated. The exercise programme was conducted in primary health care and included aerobic and muscle strengthening exercises, twice a week for 12 weeks. The results showed that the exercise intervention was feasible regarding safety and progression in the exercise programme.

The overall conclusion is that the Activity Board could be an effective method to enhance early mobilisation and postoperative recovery after abdominal cancer surgery. Patients experience the Activity Board as a facilitator for them to participate in postoperative care, which strengthens them in their rehabilitation. Also, a higher level of early mobilisation is not associated with more postoperative complications after discharge. This thesis also suggests that an exercise intervention in primary health care after a robotic-assisted radical cystectomy is feasible.

List of scientific papers

I. Porserud A, Aly M, Nygren-Bonnier M, Hagströmer M. Objectively measured mobilisation is enhanced by a new behaviour support tool in patients undergoing abdominal cancer surgery. European Journal of Surgical Oncology. 2019;45(10):1847-1853.
https://doi.org/10.1016/j.ejso.2019.04.013

II. Porserud A, Aly M, Nygren-Bonnier M, Hagströmer M. Association between daily step counts during inpatient recovery after abdominal cancer surgery and postoperative complications. [Manuscript]

III. Porserud A, Lundberg M, Eriksson J, Nygren-Bonnier M, Hagströmer M. Like I said, I would not have likely gotten up otherwise: Patient experiences of using an Activity Board after abdominal cancer surgery. Disability and Rehabilitation. 2022;11:1-8.
https://doi.org/10.1080/09638288.2022.2048097

IV. Porserud A, Karlsson P, Nygren-Bonnier M, Aly M, Hagströmer M. The feasibility of an exercise intervention after robotic-assisted radical cystectomy for urinary bladder cancer, prior to the CanMoRe-trial. [Manuscript]