Home-Based Prehabilitation for Older Surgical Patients With Frailty

作者：Daniel I. McIsaac, Susan M. Lee, Dean Fergusson, Chelsia Gillis, Rachel G. Khadaroo, Amanda Meliambro, John Muscedere, Antoine Eskander, H Moloo, Gregg Nelson, Tarit Saha, Rosaleen Chun, Pablo E. Serrano, Duminda N. Wijeysundera, Monica Taljaard, PREPARE Trial Investigator Group, Keely Barnes, Sylvain Boet, Laura Boland, Karina Branje, Rodney H. Breau, Gregory L. Bryson, Irfan Dhalla, Elijah Dixon, Gary Dobson, Mary Farnand, Alan J. Forster, Sylvain Gagné, Emily Hladkowicz, Jayna Holroyd‐Leduc, Allen Huang, Joanne Hutton, Eric Jacobsohn, John Joanisse, Ana Johnson, Stephanie Johnson, Noha M. Khalil, Gurlie Kidd, Manoj M. Lalu, Luke T. Lavallée, Tien Le, Max Levine, C.M. Love, Colin J. L. McCartney, Michael McMullen, Lucas Mellaci Bergamascki, Ronald B. Moore, Michelle Mozel, Sudhir Nagpal, Julie Nantel, Barbara Power, Celena Scheede‐Bergdahl, Laura Tamblyn-Watts, Kednapa Thavorn, Daniel Trottier, Carl van Walraven, Ilun Yang · 发表于：JAMA Surgery · 年份：2025 · DOI：10.1001/jamasurg.2025.5288 · 被引用次数：20 · 研究领域：Frailty in Older Adults、Intensive Care Unit Cognitive Disorders、Balance, Gait, and Falls Prevention

Importance: Explanatory trials suggest that prehabilitation has efficacy in improving surgical outcomes. The effectiveness of offering home-based prehabilitation across multiple centers and for older adults with frailty remains unknown. Objective: To evaluate the effectiveness of offering coach-supported, home-based prehabilitation to older surgical patients with frailty. Design, Setting, and Participants: This study is a pragmatic, parallel-arm, multicenter randomized clinical trial with embedded qualitative assessment. Clinicians and assessors were fully blinded; participants were partially blinded in that the control arm received publicly available activity and nutritional guidelines. From March 2, 2020, to February 8, 2024, participants aged 60 years and older with frailty (Clinical Frailty Scale score ≥4) scheduled for elective, inpatient noncardiac surgery were recruited from surgeon's offices at 13 centers in Canada. Data analysis was completed from October 3, 2024, to December 5, 2024. Intervention: Assignment to a home-based, multimodal program of exercise and personalized nutritional recommendations, remotely supported by coaches using a theory-based approach to enhance adherence. Main Outcomes and Measures: The coprimary outcomes were patient-reported disability 30 days after surgery using the World Health Organization Disability Assessment Schedule 2.0 and the incidence of any postoperative complication during the surgical hospitalization. Barriers to adherence we...