Home-Based Prehabilitation for Older Surgical Patients With Frailty: A Randomized Clinical Trial.
Summary
Coach-supported, home-based prehabilitation for frail older adults did not reduce 30-day disability or in-hospital complications versus usual care. Patients achieving >75% exercise adherence had lower disability but without fewer complications; adherence barriers included competing priorities and motivation.
Key Findings
- No significant difference in 30-day disability (adjusted mean difference −1.4; 97.5% CI −4.9 to 2.0; P=0.36)
- No reduction in in-hospital complications (adjusted OR 1.05; 97.5% CI 0.73–1.49; P=0.78)
- Exercise adherence >75% associated with lower disability (mean difference −4.9) but no difference in complications
Clinical Implications
Do not assume routine benefit from home-based prehabilitation in frail older adults; invest in strategies that enhance adherence and target patients most likely to benefit. Consider integrating behavioral support and monitoring to improve uptake.
Why It Matters
As a pragmatic multicenter RCT during routine care, this study challenges assumptions of universal prehabilitation benefit in frail older adults and redirects focus toward adherence and patient selection.
Limitations
- Partial blinding of participants; heterogeneous surgical population
- Adherence variability likely diluted effect; COVID-19 era logistics may have influenced engagement
Future Directions
Develop adherence-optimized, targeted prehabilitation with behavioral support, remote monitoring, and adaptive dosing; test in enriched populations with physiologic deficits and clear functional endpoints.
Study Information
- Study Type
- RCT
- Research Domain
- Prevention
- Evidence Level
- I - Pragmatic, multicenter randomized clinical trial with blinded assessment
- Study Design
- OTHER