Integrating Telerehabilitation into the Prehabilitation and Rehabilitation Pathway in Colorectal Cancer: A Protocol for a Randomized Controlled Trial

Introduction: Colorectal cancer (CRC) is a leading global malignancy, and surgery is frequently followed by complications, functional decline, and reduced quality of life. Multimodal prehabilitation and rehabilitation can improve physical recovery and psychosocial outcomes, but uptake is often limited by logistical and mobility barriers. Asynchronous telerehabilitation provides a flexible, patient-centred and scalable solution, yet its effectiveness across the perioperative CRC pathway has not been rigorously evaluated. This trial will test a multimodal asynchronous programme, delivered in prehabilitation and postoperative phases, against a standard leaflet-based approach. Methods: This single-blind, parallel-group randomized controlled trial will compare an asynchronous multimodal telerehabilitation program, delivered during a two-week prehabilitation and a four-week postoperative rehabilitation phase, against a standard leaflet-based program. Fifty-six patients undergoing elective CRC surgery will be randomized 1:1 to intervention or control. The telerehabilitation group will receive individualized exercise and education via the HEFORA digital platform, supported by asynchronous monitoring and weekly progression. The control group will receive the same structured program in a printed leaflet format, without digital supervision or updates. Assessments will be conducted at five key time points: baseline, post-prehabilitation, post-surgery (pre-rehabilitation), post-rehabilitation, and at three-month follow-up. Outcomes: The primary outcome is functional capacity, measured by the Six-Minute Walk Test (6MWT). Secondary outcomes include muscle strength, body composition, pulmonary function, physical activity, sleep quality, psychosocial well-being, health-related quality of life, treatment expectancy, usability, satisfaction, and adherence. All analyses will follow the intention-to-treat principle to preserve the benefits of randomization and ensure robust inference. Conclusions: This study will provide essential evidence on the role of asynchronous telerehabilitation in perioperative colorectal cancer management. Positive results could inform clinical guidelines, promote wider adoption of digital rehabilitation strategies, and drive a more accessible, patient-centered, and cost-effective approach to oncologic recovery.