Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Sep;135(3):582-593.
doi: 10.1016/j.bja.2025.06.003. Epub 2025 Jul 4.

Adherence to prehabilitation in adult surgical patients: a systematic review, meta-analysis, meta-regression, and qualitative synthesis

Marta I Berrio-Valencia  1 , Mariam Al-Bayati  2 , Adir Baxi  2 , Karina Branje  2 , Ingrid Chitiva-Martinez  1 , Emily Hladkowicz  2 , Gurlavine Kidd  3 , Brian Hutton  2 , Dianna M Wolfe  2 , Manoj Lalu  4 , Sylvain Boet  1 , Chelsia Gillis  5 , Daniel I McIsaac  6 ; Canadian Prehabilitation Knowledge Network
Affiliations
Meta-Analysis

Adherence to prehabilitation in adult surgical patients: a systematic review, meta-analysis, meta-regression, and qualitative synthesis

Marta I Berrio-Valencia et al. Br J Anaesth. 2025 Sep.

Abstract

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).

Keywords: adherence; exercise; nutrition; prediction models; prehabilitation; qualitative methods; systematic review.

PubMed Disclaimer

Conflict of interest statement

Declaration of interest DIM receives salary support from a Clinical Research Chair at the University of OttawaFaculty of Medicine, from the Physician Services Inc. Mid-Career Knowledge Translation Fellowship, and from The Ottawa Hospital Anesthesia Alternate Funds Association. The other authors declare no conflict of interest.

Figures

Fig 1
Fig 1
Forest plot for continuous adherence. CI, confidence interval; HIT, high-intensity training.
Fig 2
Fig 2
Forest plot for binary adherence. CI, confidence interval; IMT, inspiratory muscle training.
See this image and copyright information in PMC

References

    1. Fleurent-Grégoire C., Burgess N., McIsaac D.I., et al. Towards a common definition of surgical prehabilitation: a scoping review of randomised trials. Br J Anaesth. 2024;133:305–315. - PMC - PubMed
    1. McIsaac D.I., Gill M., Boland L., et al. Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews. Br J Anaesth. 2022;128:244–257. - PubMed
    1. Woodfield J.C., Jamil W., Sagar P.M. Incidence and significance of postoperative complications occurring between discharge and 30 days: a prospective cohort study. J Surg Res. 2016;206:77–82. - PubMed
    1. McIsaac D.I., Taljaard M., Bryson G.L., et al. Frailty as a predictor of death or new disability after surgery: a prospective cohort study. Ann Surg. 2020;271:283–289. - PubMed
    1. Aucoin S.D., Hao M., Sohi R., et al. Accuracy and feasibility of clinically applied frailty instruments before surgery: a systematic review and meta-analysis. Anesthesiology. 2020;133:78–95. - PubMed

MeSH terms