Perioperative medicine & outcomes
Home-Based Prehabilitation for Older Surgical Patients With Frailty: A Randomized Clinical Trial
Authors' conclusion
In this randomized clinical trial among older adults with frailty scheduled for surgery, assignment to home-based prehabilitation before surgery did not improve postoperative disability scores or reduce complications.
Study context
- Population
- Adults aged ≥60 years with frailty (Clinical Frailty Scale ≥4) scheduled for elective inpatient noncardiac surgery, 13 centres in Canada705 had planned surgery
- Participants
- 847 adults
- Comparison
- Coach-supported home-based prehabilitation vs usual care
- Prehabilitationn = 423
- Usual caren = 424reference
- Primary endpoint
- Coprimary: patient-reported disability (WHO Disability Assessment Schedule 2.0) 30 days after surgery; any postoperative complication during the surgical hospitalization
- Follow-up
- 30 days after surgery
Methodological detailspragmatic, parallel-arm, multicentre, embedded qualitative assessment, clinicians and assessors fully blinded; participants partially blinded
- Pragmatic
- Parallel-arm
- Multicentre
- Embedded qualitative assessment
- Clinicians and assessors fully blinded; participants partially blinded
Primary result
As reported in the abstract
Prehabilitation
23.5
mean · SD 21.8
Usual care
24.7
mean · SD 23.8
Prehabilitation
50.1%
177
Usual care
47.7%
168
Prehabilitation vs Usual careAdjusted mean difference (97.5% CI)P value
Postoperative disability score
−1.4(−4.9 to 2.0)
P = 0.36Prehabilitation vs Usual careAdjusted odds ratio (97.5% CI)P value
Complications
1.05(0.73–1.49)
P = 0.78Secondary outcomes
| Outcome | Mean difference (97.5% CI) | P value | |
|---|---|---|---|
| Disability score, participants completing >75% of prescribed exercises (subgroup) | −4.9 (−9.8 to −0.01) | P = 0.02 | |
| −10−505Difference (linear scale) |
| Outcome | OR (97.5% CI) | P value | |
|---|---|---|---|
| Complications, participants completing >75% of prescribed exercises (subgroup) | 1.06 (0.67–1.67) | P = 0.79 | |
| 0.512Odds ratio (log scale) |
- Prehabilitation enrollment duration
- 4 · median · IQR 3–7 · weeks
Barriers to adherence
- Primary barriers were competing priorities and motivation
Safety
Preoperative safety outcomes
- Did not differ between groups
Original publication
Home-Based Prehabilitation for Older Surgical Patients With Frailty: A Randomized Clinical Trial. JAMA Surg. Published 1 February 2026. doi:10.
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