WHAT MOVES PATIENTS TO PARTICIPATE IN PREHABILITATION? A MIXED-METHODS SYSTEMATIC REVIEW

M. van der Velde^1,2,3, M. van der Leeden^3,4, E. Geleijn³, C. Veenhof^5,1, K. Valkenet^5,1

¹University of Applied Science Utrecht, Innovation of Human Movement Care Research group, Utrecht, Netherlands, ²University Medical Center Utrecht, Utrecht University, Physical Therapy Science and Sports, Utrecht, Netherlands, ³Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, Netherlands, ⁴Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands, ⁵University Medical Center Utrecht, Physical Therapy Science and Sports, Utrecht, Netherlands

Background: Patients undergoing major surgery are at risk of adverse postoperative health outcomes such as complications and delayed or poor recovery. Prehabilitation offers patients the opportunity to actively contribute to their recovery by preparing themselves for their upcoming surgery. Prehabilitation programs vary widely, among other things in the number of modalities, context and degree of supervision. Patients’ attitudes towards prehabilitation influence participation in prehabilitation programs. Declining participation can result in a reduced functional capacity, delayed post-operative recovery and higher healthcare costs. An increasing number of studies have been published on patients' perceived barriers and facilitators for participation in prehabilitation. To date, no review of these studies has been published.

Purpose: The purpose of this review was to describe patient-experienced barriers and facilitators for participation in prehabilitation.

Methods: For this mixed-methods systematic review, English-language articles were searched in PubMed, EMBASE and CINAHL. Articles were eligible for inclusion if they contained qualitative and/or quantitative data on patient-reported barriers and facilitators to participation in prehabilitation in adults undergoing major surgery. The identified articles were screened by two researchers. A convergent integrated approach according to the Joanna Briggs Institute methodology for mixed methods systematic reviews was used in this study. Relevant data from the included studies were extracted and imported to Atlas.ti. Data was coded and categorized into themes, using an inductive approach.

Results: Two quantitative, 9 qualitative and 6 mixed-methods studies, published between 2007 and 2021, were included in this review. The identified barriers and facilitators were categorized into the six components of the Capability, Opportunity, Motivation, Behaviour (COM-B) model as this model seemed to fit the identified themes: psychological capacity, physical capacity, social opportunity, physical opportunity, automatic motivation, and reflective motivation. A multitude of factors were identified across the different COM-B components. Barriers included lack of knowledge of the benefits of prehabilitation and not prioritizing prehabilitation over other commitments (psychological capability), physical symptoms and comorbidities (physical capability), lack of time and limited financial capacity (physical opportunity), lack of social support (social opportunity), anxiety and stress (automatic motivation) and previous experiences and feeling to fit for prehabilitation (reflective motivation). Facilitators included knowledge of the benefits of prehabilitation (psychological capability), having access to resources (physical opportunity), social support and encouragement by a health care professional (social support), feeling a sense of control (automatic motivation) and beliefs in own abilities (reflective motivation).

Conclusions: Several factors influence the participation in prehabilitation of patients undergoing major surgery. Barriers and facilitators were identified within all six COM-B components.

Implications: In order to reach all patients and to tailor prehabilitation, it is important to consider capability, opportunity and motivation of patients. The development, implementation and evaluation of personalized prehabilitation is an important next step in which the results of this study should be considered.

Funding acknowledgements: Unfunded

Keywords:
Prehabilitation
Patient experiences

Topics:
Disability & rehabilitation
Oncology, HIV & palliative care
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? No

Reason: Systematic review