Background: Prehabilitation is hypothesised to play an important role in optimising postoperative outcomes. However, achieving high adherence can be challenging. Our objectives were to synthesise current approaches to adherence measurement and reporting, estimate prehabilitation adherence across trials, identify procedural-, programme-, or patient-level factors associated with adherence, and report barriers and facilitators to adherence.
Methods: Ovid MEDLINE, Embase, the CINAHL, PsycINFO, Web of Science, and the Cochrane CENTRAL Register of Controlled Trials were searched from inception until April 10, 2024. We included randomised trials of adults undergoing major elective surgery allocated to a prehabilitation programme, with at least one binary or continuous measure of adherence to prehabilitation, to an individual component, or both. Random-effects meta-analysis pooled overall adherence rates; meta-regression evaluated predictors of adherence. Qualitative synthesis of reported barriers and facilitators was informed by the Theoretical Domains Framework.
Results: We screened 11 652 titles and abstracts, followed by 1232 full texts, and included 105 trials (n=4941). Pooled adherence was 79% (95% confidence interval [CI] 70-88; I2=95.4%). Substantial qualitative and statistical heterogeneity existed in defining prehabilitation adherence. Only patient age was significantly associated with adherence (per year older: odds ratio 0.95 [95% CI 0.91-0.99]). Based on qualitative synthesis, common barriers were logistical issues and health conditions; facilitators included supervision by specialists and personalisation.
Conclusions: Prehabilitation adherence metrics are variable across trials and standardisation is required to improve reporting and interpretation of prehabilitation evidence. Little credible evidence identifies factors associated with adherence; however, qualitative barriers and facilitators could inform programme design and implementation.
Systematic review protocol: PROSPERO (CRD42024518851).
