Division of General Surgery, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3680K, Stanford, CA, 94305, USA.
Stanford Prevention Research Center, Stanford, CA, USA.
J Gastrointest Surg. 2023 Nov;27(11):2547-2556. doi: 10.1007/s11605-023-05857-9. Epub 2023 Oct 17.
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.
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.
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.
We identified key barriers to be addressed and facilitators to be leveraged in future prehabilitation programs.
NCT04504266.
坚持术前康复对于获得最佳效果至关重要，但目前仍不清楚导致患者无法坚持家庭为基础的康复计划的原因。我们的目的是确定并探讨接受腹部手术患者坚持术前康复的障碍和促进因素。
本研究嵌套在一项关于术前康复的单中心随机对照试验（围手术期优化增强康复（POWER））中，采用解释性序贯设计，连接整合。纳入随机分配至干预组的患者进行定量分析，并邀请其中一部分患者进行半结构化访谈。暴露因素为身体活动和健康饮食障碍的频率，结局为对术前康复这些内容的坚持情况。适当采用逻辑回归或线性回归。
在干预组的 133 名参与者中，有 116 名（87.2%）完成了初始调查（56.9%为女性，中位年龄 61 岁（IQR 49.0；69.4））。运动和健康饮食的最常见障碍分别为医疗问题（59%）和缺乏动力（31%）。身体活动障碍评分与该计划组成部分的坚持情况之间无显著相关性（比值比 0.89，95%置信区间 0.78-1.02，p=0.09）。较高的健康饮食障碍评分与干预前后地中海饮食评分较低相关（系数：-0.32，95%置信区间：-0.49；-0.15，p<0.001；和系数：-0.27，95%置信区间：-0.47；-0.07，p=0.01）。对 15 名参与者的访谈显示，通过设定目标、高效锻炼和提高自我效能，参加术前康复成为健康饮食和锻炼的促进因素。
我们确定了未来术前康复计划中需要解决的关键障碍和可以利用的促进因素。
NCT04504266。
