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Scoping report identifies factors as potential barriers and facilitators to accessing and participation of prehabilitation interventions

Published: 20 April 2023

An agile scoping review of secondary evidence by the Evidence Service at Public Health Wales has aimed to establish the existing evidence around maximising prehabilitation interventions.

Prehabilitation refers to interventions that are carried out before surgery.  They aim to reduce post-surgery complications and morbidity, and to facilitate recovery. These interventions range from nutritional advice to enable weight loss, physical activity to improve strength and mobility, help with stopping smoking or drinking, respiratory interventions such as Preoperative Exercise Therapy, or providing advice and education for pain management. 

No secondary evidence was identified on how to maximise uptake of prehabilitation interventions. However, the Evidence Service looked at what factors could work as facilitators or barriers to the uptake of prehabilitation interventions, and the evidence consistently indicated four different components which act as both facilitators and barriers: time, access, setting, and health. However, some components, such as setting acted as a facilitator or barrier depending on the surgical type or prehabilitation intervention. 

Being able to find the time within daily commitments such as work and ongoing treatment appointments was a barrier to participation, but interventions which were designed to work around a patient’s lifestyle were far more acceptable. 

The evidence also identified that locally accessible interventions acted as a facilitator, and that cost of transport, the burden of appointments and limited pre-operative time acted as barriers. 

The setting of an intervention was an important factor in influencing people to attend a prehabilitation intervention, but evidence was mixed as to whether a hospital setting was the most effective place to hold the intervention. The evidence indicated this depended on the different types of cancer that patients were living with. Those with gynaecological cancers were motivated more in non-hospital settings, while those who were preparing for major abdominal cancer surgery reported that hospital-based interventions had greater compliance levels. 

The current health of the patient was also a motivating factor in terms of perceived health and wellbeing benefits of the intervention. Conversely, feeling too unwell, experiencing side effects of their current treatment, and feeling fatigued, often acted as barrier to people’s participation in interventions. 

The agile scoping report identified a lack of secondary evidence relating to how characteristics such as ethnicity and age may influence uptake and participation, as well as intervention components including digital technology and supervision. 

The Evidence Service highlighted that we cannot tell from the evidence if these barriers and facilitators would be generalisable to other types of prehabilitation interventions, surgical disciplines or patient groups not featured in the reviews. 

Hannah Shaw, Principal Evidence and Knowledge Analyst at the Evidence Service in Public Health Wales, said:

“While there is a wealth of evidence available globally on the benefits of patients undertaking prehabilitation work, our scoping review found that there is a lack of research which looks at the motivations for doing so. 

“We hope that identifying these factors, which appear to influence people’s motivation to undertake prehabilitation interventions, will help those designing and evaluating such interventions, by highlighting important factors to consider when implementing.”