BMJ Open (Nov 2022)

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

DOI
https://doi.org/10.1136/bmjopen-2022-068797
Journal volume & issue
Vol. 12, no. 11

Abstract

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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.