Patient and Public Involvement in Prehabilitation: A Systematic Review.

ObjectiveTo systematically evaluate the extent and quality of patient and public involvement (PPI) reporting in prehabilitation programmes and research.Data SourcesKeyword searches were conducted in MEDLINE, EMBASE, CINAHL, PsycINFO and the Cochrane Central Register of Controlled Trials from 1 January 1994 to 22 October 2025.Review methodsUsing an a priori protocol registered with PROSPERO, a systematic review was conducted in accordance with PRISMA guidelines. A narrative synthesis approach was used to interpret findings across heterogeneous studies. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). A patient representative contributed to the study design and co-authored the review.ResultsFrom 14,078 records, 16 studies reporting PPI were included from the UK, Australia, Canada, USA and Spain. Most studies involved patients at multiple stages, using varied approaches including experience-based co-design. Reporting quality was suboptimal; only three studies met all items of the GRiPP2-SF checklist criteria, and none used a formal PPI reporting checklist tool.ConclusionFew prehabilitation programmes are designed with patient and public involvement; highlighting the need for collaborative approaches to improve acceptability and adherence. Although evidence of PPI is limited, several studies demonstrated sustained and meaningful involvement. Reporting remains inconsistent, underscoring the need for clearer reporting to strengthen the evidence base and support wider adoption. The findings highlight substantial opportunities for collaboration in future programmes, and further research should examine how PPI influences adherence, patient experience and the overall effectiveness of prehabilitation interventions.