Key result
Lower SES, older age, and higher surgical risk are strongly linked to digital prehabilitation non-participation.
Why the study?
Prehabilitation via a digital platform may preoperatively improve physical and mental fitness in cardiothoracic surgery patients, but reasons and predictors of trial non-participation were unknown.
What are the reasons and predictors of non-participation in a personalized digital prehabilitation care trial for patients undergoing elective cardiothoracic surgery?
Cohort (n=815)
No
What are the reasons and predictors of non-participation in a personalized digital prehabilitation care trial for patients undergoing elective cardiothoracic surgery?
Odds Ratio: 0.267 (95% CI 0.133–0.536)
p-value: p=<0.001
More than half of patients declined participation in a digital prehabilitation trial, with vulnerable patients (older, lower SES, higher risk) being the most likely to decline, highlighting the need for tailored prehabilitation options.
May bias digital prehabilitation trial results toward lower-risk patients; leaves open tailored strategies to improve enrollment equity.
OBJECTIVES: Prehabilitation through a digital platform could preoperatively improve the physical and mental fitness of patients undergoing cardiothoracic surgery, thereby improving treatment outcomes. This study aimed to describe the reasons and predictors of non-participation in a personalized digital prehabilitation care trial (Digital Cardiac Counseling randomized controlled trial) for patients undergoing elective cardiothoracic surgery. METHODS: Adult patients scheduled for elective cardiothoracic surgery at the Maastricht University Medical Center+ were approached to participate in a digital prehabilitation care trial, in which patients were informed about their care pathway, monitored for symptom progression and screened for preoperative modifiable risk factors. Baseline characteristics of all eligible patients and reasons of non-participation were registered prospectively. Predictors of non-participation were determined using logistic regression. RESULTS: Between May 2020 and August 2022, 815 patients were eligible for participation; 421 (52%) did not participate in the personalized digital prehabilitation care trial. Reasons for non-participation were 'lack of internet access or insufficient digital skills' (32%), 'wishing no participation' (39%) and 'other reasons' (30%; e.g. vision or hearing impairments, analphabetism, language barriers). Independent predictors of non-participation were age [odds ratio (OR) 1.024 (1.003-1.046), P = 0.024], socioeconomic status [OR 0.267 (0.133-0.536), P < 0.001], current smoker [OR 1.823 (1.124-2.954), P = 0.015] and EuroSCORE II [OR 1.160 (1.042-1.292), P = 0.007]. CONCLUSIONS: Half of the eligible patients did not participate in a personalized digital prehabilitation care trial. Non-participants were vulnerable patients, with a more unfavourable risk profile and more modifiable risk factors, who could potentially benefit the most from prehabilitation.
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Scheenstra et al. (2023) conducted a cohort in Elective cardiothoracic surgery (n=815). Socioeconomic status was evaluated on Non-participation in the personalized digital prehabilitation care trial (OR 0.267, 95% CI 0.133-0.536, p=<0.001). Lower socioeconomic status, older age, current smoking, and higher EuroSCORE II independently predicted non-participation in a digital prehabilitation trial for elective cardiothoracic surgery.
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