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Barriers and Facilitators of Surgical Prehabilitation Adherence from the Patient Perspective: a Mixed Method Study

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Adherence to prehabilitation is crucial for optimal benefit, but reasons for low adherence to home-based programs remain unexplored. Our aim was to identify and explore barriers and facilitators to prehabilitation adherence among patients undergoing abdominal surgery.

Methods

Nested in a single-center randomized controlled trial on prehabilitation (Perioperative Optimization With Enhanced Recovery (POWER)), this study had an explanatory sequential design with a connect integration. Patients randomized to the intervention arm were included in the quantitative analysis, and a subset of them was invited for a semi-structured interview. The exposure was the frequency of barriers to physical activity and healthy eating, and the outcome was adherence to those components of prehabilitation. Logistic or linear regression was used as appropriate.

Results

Among 133 participants in the intervention arm, 116 (87.2%) completed the initial survey ((56.9% women, median age 61 years old (IQR 49.0; 69.4)). The most frequent barriers to exercise and healthy eating were medical issues (59%) and lack of motivation (31%), respectively. There was no significant association between the barriers to physical activity score and adherence to this component of the program (OR 0.89, 95% CI 0.78–1.02, p=0.09). Higher barriers to healthy eating scores were associated with lower Mediterranean diet scores pre- and post-intervention (coef.: −0.32, 95% CI: −0.49; −0.15, p<0.001; and coef.: −0.27, 95% CI: −0.47; −0.07, p=0.01, respectively). Interviews with 15 participants revealed that participating in prehabilitation was a motivator for healthy eating and exercising through goal setting, time-efficient workouts, and promoting self-efficacy.

Conclusions

We identified key barriers to be addressed and facilitators to be leveraged in future prehabilitation programs.

Trial Registration

NCT04504266

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Funding

Stanford Cancer Center and Stanford Department of Surgery Seed Grant

Author information

Author notes

  1. Cintia Kimura and Yuning Liu contributed equally.

Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3680K, Stanford, CA, 94305, USA

    Cintia Kimura MD PhD MPH, Sarah E. Crowder BS, Carlie Arbaugh MD, Kreeti Shankar MPH, Andrew Shelton MD, Brendan Visser MD & Cindy Kin MD MS

  2. Stanford Prevention Research Center, Stanford, CA, USA

    Yuning Liu RD MSc

  3. Brigham Young University, Provo, UT, USA

    Sarah E. Crowder BS

  4. S-SPIRE Center, Stanford University, Stanford, CA, USA

    Uyen Mai BS

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  1. Cintia Kimura MD PhD MPH
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Correspondence to Cintia Kimura MD PhD MPH.

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Kimura, C., Liu, Y., Crowder, S.E. et al. Barriers and Facilitators of Surgical Prehabilitation Adherence from the Patient Perspective: a Mixed Method Study. J Gastrointest Surg 27, 2547–2556 (2023). https://doi.org/10.1007/s11605-023-05857-9

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