The impact of multimodal prehabilitation on patient activation before surgery: a cohort study

Higher patient activation (PA) correlates with better surgical outcomes but there is little evidence supporting interventions to improve PA in surgical patients. Multimodal prehabilitation, offers a personalized approach that includes goal-setting, feedback, and coaching, which may enhance PA. This study estimates the extent to which multimodal prehabilitation impacts PA in patients scheduled for elective surgery.

This cohort study included patients scheduled for elective surgery and enrolled in a multimodal prehabilitation program in Montreal, Canada. Before and after prehabilitation, patients completed questionnaires focused on PA [patient activation measure (PAM), higher = better, minimal important difference = 5 points], mental health (Hospital Anxiety and Depression Scale, higher = worse), and health literacy (Health Literacy Screening Tool, higher = better). Patients were categorized as having low (PAM ≤ 55.1) or high activation (PAM > 55.1). Data analysis was conducted using linear and logistic regression.

One hundred sixty-two patients were included (age 66 [12], 54% female, 73% cancer). Patients completed the prehabilitation program with a median of 11.6 (IQR 6.8-17.6) weeks and a compliance of 90% (IQR 74-100). At baseline, 29% of patients (n = 47) had low PA. After prehabilitation, the PAM score significantly increased in patients with low PA (+ 17.4 [95%CI + 9.94 to + 24.92], p < 0.001) but not in those with high PA (+ 0.91 [95%CI - 3.28 to + 5.11], p = 0.67). Patients that improved from low to high PA (n = 24/47; 51%) were more likely to be non-smokers (p = 0.025), have higher health literacy (p = 0.002), and lower levels of depression (p = 0.008) and anxiety (p = 0.011), compared to those who did not improve. Patients with high PA before surgery had a lower risk of respiratory complications (OR 0.21 [95%CI 0.05-0.78]).

Multimodal prehabilitation can enhance low levels of PA before surgery. This increase in PA may partially explain the beneficial effects of prehabilitation on postoperative outcomes. Incorporating PA measurement in future trials may offer valuable insights into the benefits of prehabilitation.