Identifying relative efficacy of components of prehabilitation in adult surgical patients: protocol for a systematic review and component network meta-analysis
,
Brian Hutton,
Alan Forster,
Monica Taljaard,
Jayna Holroyd-Leduc,
John Muscedere,
Duminda Wijeysundera,
Daniel I McIsaac,
Guillaume Martel,
Areti Veroniki,
Manoj Lalu,
Husein Moloo,
Timothy Jackson,
Risa Shorr,
Tom Wallace,
Dean Fergusson,
Colin McCartney,
Mary Brindle,
Emily Hladkowicz,
Julie Nantel,
Celena Scheede-Bergdahl,
Chelsia Gillis,
Marlyn Gill,
Leah Gramlich,
Franco Carli,
Julio F Fiore,
Julia Shaw,
Carlota Basualdo-Hammond,
Rachel Khadaroo,
Amanda Meliambro,
Laura Boland,
Karina Branje,
Antoine Eskander,
Cameron Love,
Ronald Moore,
Alexa L Grudzinski,
Shamsuddin Akhtar,
Marlis Atkins,
Sylvie Aucoin,
Rebecca Auer,
Paul Beaule,
Gregory Bryson,
Melani Gillam,
Dolores McKeen,
Stephane Poitras
Affiliations
University of London, London, UK
Brian Hutton
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Alan Forster
2 Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Toronto, Ontario, Canada
Monica Taljaard
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Jayna Holroyd-Leduc
Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
John Muscedere
Canadian Frailty Network, Kingston, Ontario, Canada
Duminda Wijeysundera
7Department of Anesthesia, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
Daniel I McIsaac
Anesthesiology and Pain Medicine, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
Guillaume Martel
Département de médecine familiale et de médecine d`urgence, Université Laval Faculté de médecine, Quebec, Québec, Canada
Areti Veroniki
1 Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
Manoj Lalu
1 Centre for Journalology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Husein Moloo
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Timothy Jackson
Department of Surgery, University Health Network, Toronto, Ontario, Canada
Risa Shorr
Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada
Tom Wallace
Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
Dean Fergusson
2The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Colin McCartney
14 Department of Anesthesiology, The Ottawa Hospital, Ottawa, Ontario, Canada
Mary Brindle
Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
Emily Hladkowicz
Anesthesiology and Pain Medicine, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
Julie Nantel
9 School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
Celena Scheede-Bergdahl
10 Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
Chelsia Gillis
School of Human Nutrition, McGill University, Montreal, Quebec, Canada
Marlyn Gill
2 PaCER Innovates, University of Calgary, Calgary, Alberta, Canada
Leah Gramlich
8 Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Franco Carli
From the *Department of Anesthesia and
Julio F Fiore
1Institute for Breathing and Sleep, Bowen Centre, Austin Hospital, Heidelberg, Victoria, Australia
Julia Shaw
Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
Carlota Basualdo-Hammond
Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada
Rachel Khadaroo
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
Amanda Meliambro
Patient Engagement, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
Laura Boland
Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Karina Branje
Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
Antoine Eskander
Cameron Love
Ronald Moore
Alexa L Grudzinski
Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
Introduction Prehabilitation is a high-priority intervention for patients, the public, clinicians and health systems. However, existing knowledge syntheses are generally low quality and do not provide insights regarding the relative efficacy of different prehabilitation components (eg, exercise, nutrition, psychosocial or cognitive interventions). The objective of the planned review is to evaluate the relative efficacy of different prehabilitation components to inform current care, implementation and future research.Methods and analysis We will perform a systematic review and component network meta-analysis (CNMA). We will use a peer-reviewed search strategy to identify all randomised trials of prehabilitation in adult surgical patients from Ovid Medline, Embase, the CINAHL, PsycINFO, Web of Science and the Cochrane Central Register of Controlled Trials, along with grey literature. All stages of the review and data extraction process will be performed in duplicate, following recommended best practices. To compare the relative efficacy of different prehabilitation components (prespecified as exercise, nutrition, psychosocial or cognitive interventions), we will use CNMA, an extension of network meta-analysis that allows estimation of the contributions to efficacy of each component of a multicomponent intervention through direct and indirect comparisons. We will use additive CNMA models for critical outcomes (postoperative complications, patient-reported recovery, physical recovery and length of stay); standard care will be the common reference condition. Pre-specified sensitivity and subgroup analyses will be conducted.Ethics and dissemination This review of published data does not require ethical review. Results will be disseminated via scientific conferences, peer-reviewed publications, social and traditional media and via our research network to target partners and organisations.
