# Multicomponent prehabilitation and perioperative care in older persons with frailty referred to planned orthopaedic surgery: A feasibility study

## TL;DR

This study tested a pre-surgery care program for older, frail patients and found it feasible and acceptable, with plans to refine it for a larger trial.

## Contribution

Demonstrated the feasibility of a tailored prehabilitation and perioperative care program for frail older adults before a full RCT.

## Key findings

- 30% of referred patients were screened for frailty, with 78% of eligible participants consenting to the intervention.
- High adherence to nutrition and exercise advice was observed, and 50% of participants had at least one medication change.
- Qualitative feedback emphasized the importance of individualized care and interdisciplinary collaboration.

## Abstract

To assess the feasibility and acceptability of a multicomponent prehabilitation and perioperative care intervention for older persons with frailty scheduled for elective orthopaedic surgery prior to conducting an RCT.

A mixed-methods feasibility study assessed reach, dose, data collection procedure, acceptability and adaptation. Data was collected through patient reported outcomes, electronic medical record, and interviews with patients and healthcare professionals. No pre-defined feasibility criteria were applied.

Of those referred for surgery, 30% were screened for frailty, among those eligible, 78% consented to participate. Participants received six of the eight planned phone calls, adherence to nutrition advice and exercise was high, and medication review resulted in at least one drug change for 50% of participants. Qualitative analysis identified key themes including the importance of tailoring care to individual patient needs, strong support from healthcare professionals and family members, and effective interdisciplinary collaboration. The intervention appeared feasible and acceptable to both patients and healthcare professionals. Several adaptations were implemented immediately (refined recruitment procedures, reduced number of health coaching sessions, and modified data collection method), while others were proposed (earlier involvement of geriatrician, focusing on hip and knee surgery, 48-hour follow-up, and improved integration with municipal rehabilitation services and general practitioners).

This study demonstrated the feasibility and acceptability of a prehabilitation and perioperative care intervention for older persons with frailty undergoing elective orthopaedic surgery. The proposed adaptations will inform the implementation strategy prior to conducting an RCT to evaluate effects on clinical outcomes and healthcare costs.