Enhanced mobilisation and physical rehabilitation after abdominal cancer surgery : feasibility, effects, and experiences

Sammanfattning: Cancer incidence is growing worldwide and, as advances in diagnostics, treatment, and rehabilitation are made, the numbers of cancer survivors are also increasing. Therefore, there is a need to find and evaluate methods to improve the lives of cancer survivors after treatment. Following abdominal cancer surgery, postoperative mobilisation and physical rehabilitation are recommended to improve outcomes, reduce the risk of complications, and improve health-related quality of life. However, there is a lack of evidence regarding its effects or how it should be structured to improve outcomes and promote adherence. The overall aim of this thesis was to contribute to the field of rehabilitation following abdominal cancer surgery by exploring methods to enhance postoperative mobilisation and evaluate the effects of physical rehabilitation following surgery. The goal was to facilitate patient adherence and engagement in rehabilitation and improve physical functioning and healthrelated quality of life following surgery. Study I explored healthcare professionals’ experiences of using the Activity Board as a tool to support postoperative mobilisation after abdominal cancer surgery. Seventeen healthcare professionals were interviewed, divided into four focus groups, and qualitative content analysis was used to analyse the interviews. The results indicate that the Activity Board is a tool that facilitates daily work and promotes patient participation. It was described as easy to use, providing valuable information and enabling healthcare professionals to support patients better, as well as having a positive impact on patient motivation. Study II evaluated the feasibility of using a digital version of the Activity Board, called Pedatim, to enhance mobilisation following abdominal cancer surgery. In this non-randomised feasibility trial, 20 patients were recruited and each received a Pedatim tablet to use during their stay in hospital following surgery. Based on predetermined criteria, the overall study design was deemed feasible apart from the eligibility criteria. The Pedatim tablet was also deemed scientifically feasible as a tool to enhance postoperative mobilisation. Study III evaluated the effects of an exercise intervention in primary care after radical cystectomy for urinary bladder cancer. In this randomised controlled trial, 90 patients were included and randomised to either control or intervention, with the intervention group receiving a referral to a physiotherapist following hospital discharge to perform a twice-a-week, 12-week exercise programme in primary care. The control group received encouragement to perform a simple home exercise programme. At the follow-up, four months after surgery, a positive effect could be seen in the intervention group compared to the control group in terms of physical activity in daily life, fatigue, and health-related quality of life. Study IV evaluated patients’ experiences of the exercise intervention in Study III. In this qualitative study, 20 patients were interviewed individually, and the interviews were analysed using thematic analysis. Four main themes were identified: 1) Having to adapt to new circumstances, describing the challenges regarding physical activity patients face after discharge; 2) Optimising conditions for rehabilitation, describing how practical conditions affect patients’ ability to exercise; 3) Motivated to get back to normal, describing patients’ desire to get back to normal life and the factors influencing that motivation; and 4) The importance of a supportive environment, describing the impact of social support, support from physiotherapists, and how the environment where exercise takes place influences patients’ ability to exercise. In conclusion, enhancing postoperative mobilisation following abdominal cancer surgery by using tools such as the Activity Board and the Pedatim tablet is feasible and useful for both patients and healthcare professionals. These tools increase patient motivation, participation, and adherence, as well as facilitating healthcare professionals’ work in supporting patients’ postoperative mobilisation. Furthermore, exercise in primary care following radical cystectomy for urinary bladder cancer improves physical activity in daily life, reduces fatigue, and has a positive impact on health-related quality of life compared to a simple home exercise programme. Patients who exercised in primary care following radical cystectomy were also positive towards exercise because they were motivated to get back to normal life. However, they did face challenges when arriving home from surgery, which affected their ability to exercise, and therefore conditions need to be optimised to facilitate patients’ rehabilitation.