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Meta-Analysis
. 2025 Feb;27(2):e70023.
doi: 10.1111/codi.70023.

Evaluating the therapeutic quality of prehabilitation programmes in patients scheduled for colorectal surgery: A systematic review and meta-analysis

Evy E J Jetten  1   2 , Ruud F W Franssen  3 , Melissa J J Voorn  4   5 , Roberto Falz  6 , Martin Busse  6 , Bart C Bongers  7   8 , Maryska L G Janssen-Heijnen  2   9 , Thomas J Hoogeboom  10
Affiliations
Meta-Analysis

Evaluating the therapeutic quality of prehabilitation programmes in patients scheduled for colorectal surgery: A systematic review and meta-analysis

Evy E J Jetten et al. Colorectal Dis. 2025 Feb.

Abstract

Aim: The aim of this work was to evaluate whether the therapeutic quality of exercise prehabilitation programmes is associated with their effectiveness to preoperatively improve aerobic fitness and reduce postoperative complications and length of hospital stay in patients scheduled for colorectal surgery.

Method: Three electronic databases (PubMed, Embase and CINAHL) were systematically searched (up to October 2023) for randomized controlled trials that investigated the effects of prehabilitation before colorectal resection. Methodological quality and therapeutic quality were assessed using, respectively, the Cochrane Risk of Bias 2 tool and the i-CONTENT tool. Studies were divided into four subgroups based on the estimated risk of bias and risk of ineffectiveness.

Results: Fourteen studies were included, comprising 986 patients. Meta-analysis showed that, in general, prehabilitation improved preoperative aerobic fitness but did not improve postoperative outcomes. No differences were found between the four subgroups; however, only one study (7%) had a low risk of bias in combination with a low risk of ineffectiveness.

Conclusion: The fact that only one study had a low risk of bias in combination with a low risk of ineffectiveness precluded us from establishing an association between therapeutic quality and the effectiveness of prehabilitation on postoperative outcomes. The quality of future prehabilitation research with exercise interventions should be improved by using an assessment tool during the design phase of prehabilitation programmes.

Keywords: colorectal cancer; exercise programme; preoperative care; preoperative training; presurgical.

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Conflict of interest statement

Thomas J. Hoogeboom was involved in the development of the i‐CONTENT tool. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

FIGURE 1
FIGURE 1
PRISMA flow chart of study inclusion.
FIGURE 2
FIGURE 2
Meta‐analysis of the effect of prehabilitation versus usual care for the outcome preoperative 6‐min walk test distance, stratified for risk of ineffectiveness.
FIGURE 3
FIGURE 3
Meta‐analysis of the effect of prehabilitation versus usual care on the outcome overall postoperative complications, stratified for risk of ineffectiveness.
FIGURE 4
FIGURE 4
Meta‐analysis prehabilitation versus usual care for the outcome severe postoperative complications, stratified for risk of ineffectiveness.
FIGURE 5
FIGURE 5
Meta‐analysis prehabilitation versus usual care for the outcome length of hospital stay, stratified for risk of ineffectiveness.
See this image and copyright information in PMC

References

    1. Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J. 2011;5(5):342–348. - PMC - PubMed
    1. van der Hulst HC, van der Bol JM, Bastiaannet E, Portielje JEA, Dekker JWT. Surgical and non‐surgical complications after colorectal cancer surgery in older patients; time‐trends and age‐specific differences. Eur J Surg Oncol. 2023;49(4):724–729. - PubMed
    1. Minnella E, Carli F. Prehabilitation and functional recovery for colorectal cancer patients. Eur J Surg Oncol. 2018;44(7):919–926. 10.1016/j.ejso.2018.04.016 - DOI - PubMed
    1. Silver JK, Baima J. Cancer prehabilitation: an opportunity to decrease treatment‐related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. Am J Phys Med Rehabil. 2013;92(8):715–727. - PubMed
    1. Clifford K, Woodfield JC, Tait W, Campbell HA, Baldi JC. Association of preoperative high‐intensity interval training with cardiorespiratory fitness and postoperative outcomes among adults undergoing major surgery: a systematic review and meta‐analysis. JAMA Netw Open. 2023;6(6):e2320527. - PMC - PubMed