In preparation of a randomized controlled trial, this study aimed to assess the feasibility and acceptability of a multicomponent prehabilitation and perioperative care intervention for frail older adults undergoing planned orthopaedic surgery.
This feasibility study (December 1st 2023 and March 22th 2024) combined quantitative and qualitative data to explore reach, dose, potential effect, and acceptability.
The intervention consisted of a 4-week prehabilitation intervention individualised to optimise nutrition and exercise, and review of medication list, and a perioperative care intervention provided by a specialised nurse, a physiotherapist and a geriatrician in collaboration with the patient’s relatives, general practitioners and/or homecare until discharge.
Data on dose, reach and potential effect were collected from electronic patient records, and patient-reported outcome measures. Data on acceptability were collected from interviews with patients and health providers.
Patients were included if aged 65 years or above, referred for planned surgery in shoulder, hip, knee or spine, and assessed frail by the Brief-Multidimensional Prognostic Index.
According to reach, 39/131 patients (30%) were screened for frailty, and 14/18 eligible patients (78%) were recruited. Mean age was 76 years, 80% were females, 71% lived alone, and 79% took seven or more drugs. Four patients dropped out; two due to traumatic fall and two due to complicated surgery.
In terms of dose, ten patients completed the intervention and received an average of six phone calls, and medication reviews resulted in changes in at least one drug.: All patients consumed a variety of protein products and reported their adherence to physical activities with a mean score of 21 points (SD 4.4) out of 24, representing the highest experienced.
Regarding potential effect, length of hospital stay within 90 days was 1 day (IQR: 1-3), and one patient was acutely readmitted.
The qualitative analysis highlighted three key factors: 1) Individualised intervention: participants found the intervention acceptable when individualised, which enhanced motivation and engagement, 2) Support systems: Consistent support from providers and relatives was critical for ensuring adherence, and 3) Sustained behaviour change: The long-term adherence to nutrition and physical activity post-intervention demonstrated that participants viewed the intervention as both useful and sustainable.
The intervention proved feasible and acceptable among frail older adults and health providers.
Physiotherapists play a crucial role in interdisciplinary, individualised prehabilitation programs for frail older adults prior to planned surgery. They offer essential knowledge and psychological support that fosters long-term motivation and adherence to physical activity.
Frail older adults
Surgery
