Home-based, virtually supported multimodal prehabilitation compared with usual care prior to major surgery: a multicentre, pragmatic pilot randomised trial

Background: A pragmatic, multicentre randomised trial of virtually supported, home-based prehabilitation is required to evaluate effectiveness in generalisable settings; however, feasibility is unknown. Methods: This was a pragmatic, parallel-arm, multicentre internal pilot randomised controlled trial. Adults aged 18 years or older preparing for planned, inpatient non-cardiac, non-orthopaedic surgery were recruited from surgeons' offices at five Canadian centres (30 January to 11 July 2024). Participants were randomised to a virtually supported home-based prehabilitation programme (exercise, protein supplementation, psychosocial support) delivered by trained coaches using a theory-based approach, or to usual care. Feasibility outcomes were recruitment (target >6 participants/centre/month), adherence (>75%), and outcome completeness (>90%). Barriers and facilitators were assessed using a validated Theoretical Domains Framework (TDF) survey. Cluster analyses explored patterns of TDF responses and associations with adherence. Results: <0.001) and explained 28% of observed variation in adherence to prehabilitation. Conclusions: A pragmatic, multicentre trial of virtually supported home-based multimodal prehabilitation is feasible. Findings support progression to a fully powered trial. Observed associations between perceived barriers, facilitators, and adherence should be validated. Trial registration: ClinicalTrials.gov NCT06042491.