Facilitators and barriers to participation in prehabilitation prior to orthopaedic elective surgery - a qualitative study with elderly (pre-)frail patients.

BACKGROUND

Patients with frailty syndrome have limited functional resources and an increased risk of postoperative complications. Prehabilitation may reduce adverse events and improve postoperative recovery. This study aimed to investigate the facilitators and barriers to participation in prehabilitation prior to elective surgery from the perspective of elderly (pre-)frail patients.

METHODS

This qualitative study was nested within the PRAEP-GO trial, a multicentre randomised controlled trial currently investigating the (cost-)effectiveness of multimodal prehabilitation for elderly (pre-)frail patients in Germany. From February to April 2023, semi-structured face-to-face interviews were conducted with patients allocated to the intervention group of the PRAEP-GO trial. After verbatim transcription of the interviews, data were analysed using content-structuring qualitative content analysis. Results were synthesised using the capability, opportunity, motivation and behaviour (COM-B) model.

RESULTS

Eight patients with a mean age of 78.5 ± 3 years were interviewed in their homes. All interviewees had an indication for an orthopaedic surgery and had participated in the prehabilitation programme offered within the PRAEP-GO trial. In total, 32 facilitators and 25 barriers to participation were identified. These could be assigned to the entire spectrum of the COM-B model. The focus on individual needs, personalised advice from healthcare professionals and a well-organised prehabilitation programme facilitated participation in prehabilitation. Gaps in knowledge, limited physical functioning, (co-)morbidities and an inflexible attitude were identified as barriers.

CONCLUSIONS

These insights from the elderly (pre-)frail patient's perspective are an essential addition to the quantitative data generated in prehabilitation trials. The identified facilitators and barriers should be considered in the future implementation of prehabilitation programmes for this population.

TRIAL REGISTRATION: PRAEP-GO trial: ClinicalTrials.gov (NCT04418271; June 1, 2020), Qualitative study: Open Science Framework Registries (osf.io/xnbqc; February 18, 2023).