Project highlighted: Fitter into your surgery or treatment

Name: Prehabilitation in the home environment for people with cancer
Goal: To organise prehabilitation as close to the living environment of people with cancer as possible using wearable technology and remote physical therapy
Intended result: an affordable and scalable blended prehabilitation program
Partners: Medical Delta Living Lab Better In Better Out, The Hague University of Applied Sciences, Rotterdam University of Applied Sciences, Healthy Chronos, B&B Healthcare
Status: Voucher awarded by ZorgTech innovation programme; project starts in June 2022

Getting fit before an operation or treatment: following a so-called 'prehabilitation program' promotes recovery after an operation or treatment. This has a positive effect, especially on older people. All the more reason, therefore, to get older people as fit and healthy as possible prior to a course of treatment or surgery. However, there are too few people and resources to provide tailored guidance to patients. E-health tools often only provide part of the solution and are dependent on the self-sufficiency of the patient.

In Medical Delta Living Lab Better In Better Out, De Haagse Hogeschool and Hogeschool Rotterdam are working with healthtech start-up Healthy Chronos and physiotherapy practice B&B Healthcare on a project to organise prehabilitation in the living environment of people with cancer. Through the use of smartwatches and activity trackers and a prehabilitation dashboard from Healthy Chronos for the physiotherapist, people can be supervised both physically in the first-line physiotherapy practice, and remotely at home. An important goal of the project is to remove the bottlenecks to using this technology in the patient's living environment. Prehabilitation thus becomes more affordable and scalable. Ultimately, this should lead to prehabilitation becoming available to larger groups of people with cancer.

The project recently received a voucher from the ZorgTech innovation program, a joint program of MRDH, InnovationQuarter, Medical Delta, TNO and the province of South Holland. The program is intended to promote innovation in healthcare through the application of technology.

Professional guidance at home

Many e-health applications rely on the self-reliance of patients and their informal caregivers. This produces variable results. On the other hand, there are often no people and resources to provide personal guidance on prehabilitation. The project consortium wants to develop a mode in which physiotherapists in combination with the deployment of a patient lifestyle monitoring platform can set up personalized programs and prehabilitation becomes available to more people.

Various wearables and measurements come together on this platform; a dashboard then gives the patient, informal caregiver and caregiver insight into personal lifestyle, (physical) capabilities and relevant outcome measures during the prehabilitation process. This makes it easier to make decisions about prehabilitation in the patient's own environment and under supervision. It also replaces part of the physical contact moments.
For a patient, this means an intensive intake with the physiotherapist. A start measurement is taken, after which the targeted exercises are gone through. The physiotherapist ensures that the patient learns how to use the various measuring methods and wearables. "From that moment on, regular online peer reviews take place, during which the physical parameters are discussed and interpreted," says Rémondo Goedkoop, physiotherapist at B&B Healthcare. "Subsequently, advice and tips are given, linked to these parameters, to achieve the most beneficial treatment effect."

B&B Healthcare participates in the innovation programme because they believe that the use of wearables within oncology care is a very suitable and practical form to provide support and insight at times when no healthcare professional is present. "With earlier and more accurate data analysis, patients can receive faster and tailored care solutions. This can lead to the best health outcome. In addition, they benefit from the convenience of remote monitoring, rather than having to go to a practice to receive care," says Goedkoop. "The use of wearables in remote care and customized diagnosis and treatment plans have the potential to reduce healthcare costs associated with the traditional healthcare model."

Future healthcare professional gets to know blended healthcare

Students from The Hague University of Applied Sciences are conducting research into the practical implementation of the solution as part of the Medical Delta Living Lab Better In Better Out. They are looking at the experiences of patients and caregivers within the blended prehabilitation program and the applicability in practice.

For students, the knife cuts both ways, says Dr. Lottie Kuijt, senior lecturer at De Haagse Hogeschool and one of the Living Lab leaders of the Medical Delta Living Lab Better In Better Out. "Not only the outcomes of the project, but also the project itself is interesting for the participating students. They experience how they can apply a technological innovation in their daily work as a physical therapist and nurse and see what the effects are for patients and caregivers. They work in interdisciplinary groups on the assignments. For the healthcare professional of the future, this is a valuable addition, because in their work they will increasingly have to deal with this type of blended healthcare."

Learning together about successful application

The aim is to let fifty patients with cancer from Haaglanden MC and possibly other hospitals participate. Together with them and B&B Healthcare, the most optimal practical implementation of the solution will be sought. The oncological physiotherapists of B&B Healthcare will guide and monitor the participants during their program.

For Healthy Chronos, the project and the voucher scheme of the innovation program ZorgTech offers an excellent opportunity to test their own platform in a very practical setting. For more and more people with cancer, prehabilitation is part of their care path. This is a positive development. We want to offer people with cancer the opportunity to prehabilitate in their own living environment. At the same time, we want to develop a scalable and affordable model. This way, we lower the threshold to offer prehabilitation as standard care for larger groups of people with cancer," says Pieter Beynen, co-founder of Healthy Chronos.

The project will be part of the course for third- and fourth-year Physical Therapy and Nursing students and started in June. The first results are expected in the first quarter of 2023.