Maximising uptake of prehabilitation interventions: an agile scope of the secondary literature  

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Introduction

Prehabilitation means support offered before surgery to help people improve their health and fitness. This can include exercise, nutrition support, stopping smoking or drinking, breathing exercises, education, or a mix of these. Better health before surgery can help reduce complications and support recovery. 

Although many studies look at how well these interventions work after surgery, there is much less clarity on what helps people take them up in the first place. Welsh Government asked us to look at this because understanding uptake is essential for designing programmes that people can and will use. 

This scoping report gives an overview of the best available evidence from high‑quality reviews on what affects people’s willingness and ability to join prehabilitation programmes.

Main points

How up to date is this evidence?

We carried out this review in March 2023 and included studies published in English from 2010 onwards. 

What we found

We did not find reviews that directly examined how to maximise uptake of prehabilitation. Instead, we focused on factors that may act as barriers or facilitators to taking part. We identified three systematic reviews, one umbrella review, and one scoping review. 

The reviews looked at different aspects of prehabilitation, such as what programmes include, how they may support health or experience, costs, and the effects of pre‑surgery exercise. 

The evidence shows a range of factors that may influence whether people choose to join and stay involved in prehabilitation programmes. 

These factors appear to interact in complex ways. Individual components can affect several parts of the process, such as recruitment, participation, adherence, and retention, as well as personal factors like motivation, acceptability, and satisfaction. 

Common barriers to taking up or staying engaged included: 

• Limited time due to work or personal commitments 
• Travel distance or time 
• Where the programme takes place (hospital or home) 
• Health issues linked to current symptoms or treatment 
• Common facilitators included: 
• Flexibility and the ability to fit activities around everyday life 
• Local and convenient services 
• Belief that the programme will support health and wellbeing 
• Support from friends, family, or healthcare professionals, and being able to track progress 

Many components acted as both barriers and facilitators. Time, access, setting, and health were the most common examples. For instance, the setting of the programme could help or hinder uptake depending on the type of surgery or the type of prehabilitation offered. 

We found limited evidence on how ethnicity, age, digital technology, supervision, or specific surgical groups (such as orthopaedic patients) may influence uptake and participation. 

What this means

This scoping report gives an overview of factors that may influence whether people take up prehabilitation. However, we did not find evidence that directly explains how to maximise uptake. Most of the findings came from two reviews involving people with gynaecological or colorectal cancer, so it is hard to know how well they apply to other surgeries, other types of prehabilitation, or other patient groups. 

The evidence suggests that people’s preferences vary across different surgical populations. For example, views on where prehabilitation should take place may differ between groups. These differences highlight the need for more detailed research to understand what people value in terms of intervention type, duration, and setting. 

We also found gaps in the evidence. Little is known about how factors such as age, ethnicity, digital delivery, or the level of supervision may affect uptake and participation. These areas could be explored further through primary research, including qualitative studies that offer deeper insights into people’s motivations, barriers, and support needs. 

The factors identified in this report may help policymakers and services understand why some people choose to take part in prehabilitation while others do not. These insights can be used to guide early thinking when designing or testing prehabilitation programmes, while recognising that further research is needed to build a more complete picture. 

Technical information

We carried out a scoping review to give a broad overview of the evidence on this topic. We summarised what the original authors reported; we did not re‑interpret their findings. We extracted key factors relevant to our questions from systematic reviews and summarised them briefly in the report.