Development and preliminary evaluation of a short web-based home multimodal prehabilitation program for patients undergoing major surgery: a single-arm clinical trial

Prehabilitation is a process for optimizing preoperative functional capacity, yet its implementation efficiency and patient adherence remain challenging. This study aimed to develop a short home-centered multimodal prehabilitation program administered via a digital platform and to preliminarily evaluate changes in preoperative functional capacity and patient adherence among patients scheduled for major elective surgery. This prospective single-arm trial included patients who were candidates for major surgery. A web-based prehabilitation program was established using a cloud-based mobile application to deliver individualized interventions, including medical and lifestyle guidance, aerobic exercise, resistance training, respiratory training, nutritional support, and psychological support. The absolute change in the six-minute walk distance (6MWD) from the initial assessment to the immediate preoperative day was defined as the primary study endpoint. Secondary outcomes included changes in body mass index (BMI); the rate of smoking cessation; grip strength; pulmonary function; the Duke Activity Status Index (DASI); the Nutritional Risk Screening 2002 (NRS-2002); the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight scale (FRAIL scale); and the Hospital Anxiety and Depression Scale (HADS). Adherence was quantified using backend data from the application. The statistical association between changes in the 6MWD and adherence was tested, and multivariable linear regression was conducted to evaluate the associations between adherence and clinical characteristics. Forty patients were analyzed. Compared with the baseline, the preoperative 6MWD significantly increased (mean difference = 33.36 m, 95% confidence interval (CI) [13.48, 53.23], p = 0.002, adjusted p = 0.03). There was no evidence of statistically significant change across the set of secondary outcome measures. The change in the 6MWD was positively correlated with adherence ( r = 0.41, 95% CI [0.10, 0.64], p = 0.009). A significant association was observed between sex and adherence in the regression model (mean difference = -17.91, 95% Bootstrap CI [-29.80, -5.30], p = 0.01). In this prospective single-arm study, participation in a short web-based home multimodal prehabilitation program was associated with an improvement in preoperative 6MWD. Greater adherence was correlated with greater improvement in 6MWD. Registry: ClinicalTrials.gov. Trial registration number: NCT05324345. Registration date: 31 March 2022.