Exploring the acceptability of and adherence to prehabilitation and rehabilitation in patients undergoing major abdominal surgery: A systematic review and meta-analysis

Alsuwaylihi, Abdulaziz; Skořepa, Pavel; Prado, Carla M.; Gomez, Dhanny; Lobo, Dileep N.; O'Connor, Dominic

Abstract

Background and aims: Prehabilitation combines exercise, nutritional, and psychological interventions administered before surgery to improve patient outcomes. This comprehensive review and meta-analysis examined the feasibility, adherence, and effectiveness of prehabilitation in frail, high-risk individuals undergoing major abdominal surgery. Methods: We searched the Cochrane Central Register of Controlled Trials, Web of Science, MEDLINE, Embase, and Cumulative Index to Nursing & Allied Health Literature (CINAHL) databases to identify relevant studies evaluating prehabilitation programs published between 2010 and 2023, either as observational studies or randomized clinical trials (RCTs). Results: The 23 articles (13 RCTs and 10 observational studies) included 1849 older male and female patients aged 68.7 ± 7.2 years. Nineteen of the included studies reported on adherence to prehabilitation programmes, which was generally good (>75%) over different models, settings, and durations. Factors such as patients' desire for expedited surgery, self-assessment of fitness, personal and professional obligations, health issues, holidays, and advancement of surgery dates negatively affected adherence to prehabilitation programmes. When compared with rehabilitation or standard pre- and post-surgical care, prehabilitation was associated with a 25%, albeit not statistically significant reduction in postoperative complications, according to data from 14 studies reporting on postoperative complications (OR 0.75, 95% CI 0.48 to 1.17, P = 0.43; I2 = 65%). Prehabilitation has been found to improve the 6-min walk test significantly by 29.4 m (MD +29.4 m, 95% CI 5.6 to 53.3, P = 0.02; I2 = 39%), compared with rehabilitation or standard pre- and post-surgical care. Conclusion: Prehabilitation was acceptable to patients, with good adherence, and improved physical function.

Citation

Alsuwaylihi, A., Skořepa, P., Prado, C. M., Gomez, D., Lobo, D. N., & O'Connor, D. (2024). Exploring the acceptability of and adherence to prehabilitation and rehabilitation in patients undergoing major abdominal surgery: A systematic review and meta-analysis. Clinical Nutrition ESPEN, 63, 709-726. https://doi.org/10.1016/j.clnesp.2024.07.1060

• Journal Article Type: Article
• Acceptance Date: Jul 30, 2024
• Online Publication Date: Aug 13, 2024
• Publication Date: Oct 1, 2024
• Deposit Date: Aug 1, 2024
• Publicly Available Date: Aug 14, 2025
• Journal: Clinical Nutrition ESPEN
• Electronic ISSN: 2405-4577
• Peer Reviewed: Peer Reviewed
• Volume: 63
• Pages: 709-726
• DOI: https://doi.org/10.1016/j.clnesp.2024.07.1060
• Keywords: prehabilitation; abdominal surgery; adherence; complications; patient perceptions
• Public URL: https://nottingham-repository.worktribe.com/output/37886452
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S240545772401266X