Digital shift benefits prehab patients throughout the pandemic

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The PREPWELL programme is designed to support patients by helping them improve their fitness, health and wellbeing before an operation or treatment. The service is run by South Tees Hospitals and Public Health South Tees.

The programme launched in January 2018, and it was the UK’s first comprehensive, supervised community-based service. It helps patients access progressive support for several preoperative risk factors, in a one-stop setting, in the weeks before surgery.

The work has been significantly funded through You’ve Got This, and PREPWELL’s unique approach means that multiple partners and Sport England can benefit from the learning and insight.

A range of healthcare professionals, including doctors, physiotherapists, exercise scientists and public health experts, deliver the programme. They are all united in their commitment and enthusiasm to encourage people to become physically active.

Before the pandemic, PREPWELL had successfully run face-to-face group exercise classes alongside other lifestyle support for the local community at The Live Well Centre, Middlesbrough.  

However, in line with Government guidance, in April 2020, these sessions were suspended as the country went into lockdown.

Despite this enormous setback, the PREPWELL team were determined to find a way to continue supporting patients. Rising to the challenge, they quickly implemented home-based exercise options that the PREPWELL team could remotely supervise. 

A digital prehab programme was also created to continue to support patients in the build-up to surgery. Paper-based and audiovisual resources were also provided to help patients who could not access the digital offer.

During the pandemic, digital became more critical as it was a vital tool in enabling the prehabilitation service to continue. In addition, the rapid shift from face-to-face interaction to a digital service has provided a lot of learning into how patients have adapted and adjusted to remote support. 

Insight has shown that whilst most people are willing to participate face-to-face, many indicated a preference for remotely supervised home-based alternatives. These people would likely have missed out if this hadn’t been available. 

The team has also learned that patients encounter various barriers when accessing face-to-face support. These include travel difficulties, juggling other weekday commitments, or lack of confidence in a group environment. This learning has influenced and shaped the future programme beyond the pandemic. 

As a result, a remotely supervised alternative for those unwilling or unable to access face-to-face services alongside an independent aligned digital prehabilitation offer has been approved. The PREPWELL team will continue to work closely with You’ve Got This to develop the new programme.

Esther Carr, senior physiotherapist and PREPWELL project manager, said: “Implementing a digital prehabilitation offer has allowed us to enhance the service we provide to patients. 

“The vision for the future is that we will offer a menu of options that will give patients more flexibility and the ability to choose what most suits them.

“Accessing funding for both prehabilitation and digital prehabilitation services emphasises our enthusiasm to identify and grasp opportunities as they arise”. 

PREPWELL’s close partnership with the hospital and the use of insight has enabled the team to identify a system change opportunity, present a proposal and test it through the benefit of additional funding from You’ve Got This. It has also helped them build a trusting relationship with the hospital team, who themselves are also demonstrating the success of the approach with other surgical provisions within James Cook University Hospital and beyond.

As we come out of the pandemic, the prehab team are looking forward to delivering the service as intended and resuming the physical activity support in person whilst maintaining the safety of patients. 

Looking to the future, the PREPWELL team is focusing on promoting the service throughout the entire hospital and externally. In addition, they will explore how prehab can be embedded into clinical pathways for all patients, as it is currently only underway in orthopaedics, and how prehabilitation activity can be implemented into the community or at home provision. 

To find out more about PREPWELL, visit

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