Risco Raquel, Sebio-García Raquel, González-Colom Rubèn, Ubré Marta, Dana Fernando, Iglesias-García Edgar, Martínez-Pallí Graciela
Anesthesiology Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain.
August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
J Clin Med. 2025 May 29;14(11):3813. doi: 10.3390/jcm14113813.
The real impact of prehabilitation in the healthcare setting is controversial due to the efficacy-effectiveness gap. The effectiveness of prehabilitation in real-world scenarios has been associated with program attrition and adherence. This study aimed to identify factors influencing adherence to a multimodal prehabilitation program for patients undergoing major surgery. This is a analysis of a prospective trial conceived to explore the implementation of prehabilitation in a real-life setting. Participants were patients enrolled in our multimodal prehabilitation program, candidates for major surgery, and at high risk for postoperative complications. Sociodemographic and clinical variables were studied, with adherence to the program as the primary outcome. Descriptive analyses were conducted to examine associations between adherence and the study variables. A binary logistic regression model was applied to identify predictors of adherence. Among the 559 patients included in the study, 356 (63.7%) were labelled as adherent. The analysis revealed significant associations between adherence and working status, type of exercise program prescribed ( < 0.001), smoking status ( = 0.023), age (t = -3.00, = 0.003), comorbidities (t = -2.19, = 0.029), and self-reported physical activity (t = -2.45, = 0.015). The logistic regression identified as independent factors the type of exercise prescription, smoking status, residential area, working status, and neoadjuvant therapy. The predictive model demonstrated good specificity (86.1%) but lower sensitivity (50.6%), suggesting its utility in identifying patients at risk of non-adherence. Multiple factors influence adherence in prehabilitation programs. Our model exhibited good accuracy and specificity, but poor sensitivity.
由于疗效与效果之间存在差距，术前康复在医疗环境中的实际影响存在争议。术前康复在现实场景中的效果与项目参与度和依从性相关。本研究旨在确定影响接受大手术患者对多模式术前康复项目依从性的因素。这是一项对前瞻性试验的分析，该试验旨在探索在现实生活环境中实施术前康复。参与者是参加我们多模式术前康复项目的患者，他们是大手术的候选者，且术后并发症风险高。研究了社会人口统计学和临床变量，并将对项目的依从性作为主要结果。进行描述性分析以检查依从性与研究变量之间的关联。应用二元逻辑回归模型来确定依从性的预测因素。在纳入研究的559名患者中，356名（63.7%）被标记为依从者。分析显示，依从性与工作状态、规定的运动项目类型（<0.001）、吸烟状态（=0.023）、年龄（t=-3.00，=0.003）、合并症（t=-2.19，=0.029）和自我报告的身体活动（t=-2.45，=0.015）之间存在显著关联。逻辑回归确定运动处方类型、吸烟状态、居住地区、工作状态和新辅助治疗为独立因素。预测模型显示出良好的特异性（86.1%）但较低的敏感性（50.6%），表明其在识别有不依从风险患者方面的效用。多种因素影响术前康复项目的依从性。我们的模型表现出良好的准确性和特异性，但敏感性较差。
