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Purpose <p>Adherence plays a critical role in determining the effectiveness of prehabilitation; however, achieving and maintaining it remains challenging. This systematic review and meta-analysis examined adherence rates and factors influencing participation in prehabilitation for gastrointestinal cancer surgery.</p> Methods <p>Six databases (Embase, Medline, Web of Science, CINAHL, PsycINFO, and Cochrane) were searched to September 2024 for studies reporting prehabilitation interventions (unimodal or multimodal) and adherence. Data extraction, risk of bias, and certainty assessment were undertaken. Pooled adherence rates were analysed using random-effects meta-analysis, with meta-regression exploring determinants. The protocol was registered with PROSPERO (CRD42022301626).</p> Results <p>Forty studies were included: 22 multimodal and 18 unimodal. Data from 32 studies (<i>n</i> = 1619; mean age 69 ± 6.8&#xa0;years) revealed a pooled mean adherence rate of 75% (95% CI 66–84%). Adherence was higher for exercise (82%) and nutrition (83%) interventions but substantially lower for psychological support (42%). Multimodal programmes showed reduced adherence (67%) compared to unimodal approaches (83%). Meta-regression identified intervention duration as the only significant predictor, with a 2.6% decrease per additional day (<i>p</i> = 0.0046). Common barriers to adherence included logistics, exercise intensity, time constraints, and tolerance to nutritional supplements. Study-level limitations included inconsistent definitions and measurements of adherence, reliance on self-reported measures, and low certainty of evidence.</p> Conclusions <p>Adherence to prehabilitation in gastrointestinal cancer surgery is generally moderate to high but lower in multimodal programmes and declines as the duration of the intervention increases. Standardising adherence reporting and integrating behavioural strategies and digital tools could improve adherence, equity, and outcomes.</p> Protocol registration <p>The protocol for this systematic review and meta-analysis was registered with the PROSPERO database (CRD42022301626): <a href="https://www.crd.york.ac.uk/PROSPERO/view/301626">https://www.crd.york.ac.uk/PROSPERO/view/301626</a>.</p>

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Bridging the gap between prescription and participation: a systematic review and meta-analysis of factors influencing adherence to prehabilitation in gastrointestinal cancer surgery

  • 期刊论文

  • 发表日期：

    2025年10月22日

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  • Kristy-Lee Raso,
  • Michael David,
  • Alice Melton,
  • Sim Yee Cindy Tan,
  • Janette L. Vardy

摘要

Purpose

Adherence plays a critical role in determining the effectiveness of prehabilitation; however, achieving and maintaining it remains challenging. This systematic review and meta-analysis examined adherence rates and factors influencing participation in prehabilitation for gastrointestinal cancer surgery.

Methods

Six databases (Embase, Medline, Web of Science, CINAHL, PsycINFO, and Cochrane) were searched to September 2024 for studies reporting prehabilitation interventions (unimodal or multimodal) and adherence. Data extraction, risk of bias, and certainty assessment were undertaken. Pooled adherence rates were analysed using random-effects meta-analysis, with meta-regression exploring determinants. The protocol was registered with PROSPERO (CRD42022301626).

Results

Forty studies were included: 22 multimodal and 18 unimodal. Data from 32 studies (n = 1619; mean age 69 ± 6.8 years) revealed a pooled mean adherence rate of 75% (95% CI 66–84%). Adherence was higher for exercise (82%) and nutrition (83%) interventions but substantially lower for psychological support (42%). Multimodal programmes showed reduced adherence (67%) compared to unimodal approaches (83%). Meta-regression identified intervention duration as the only significant predictor, with a 2.6% decrease per additional day (p = 0.0046). Common barriers to adherence included logistics, exercise intensity, time constraints, and tolerance to nutritional supplements. Study-level limitations included inconsistent definitions and measurements of adherence, reliance on self-reported measures, and low certainty of evidence.

Conclusions

Adherence to prehabilitation in gastrointestinal cancer surgery is generally moderate to high but lower in multimodal programmes and declines as the duration of the intervention increases. Standardising adherence reporting and integrating behavioural strategies and digital tools could improve adherence, equity, and outcomes.

Protocol registration

The protocol for this systematic review and meta-analysis was registered with the PROSPERO database (CRD42022301626): https://www.crd.york.ac.uk/PROSPERO/view/301626.