What drives patient behavior change in perioperative interventions?: a systematic review of mechanisms of prehabilitation

Abstract

Background: Physical activity prehabilitation interventions improve postoperative outcomes in surgical populations, but there is little evidence on behavior change mechanisms and techniques behind the success of interventions. This study aims to systematically identify mechanisms and techniques of behavior change and to review the effectiveness of these interventions. Method: A search was conducted on Embase, Medline, PsycINFO, CINAHL and PubMed electronic databases following PRISMA guidelines. Data were extracted using the Cochrane Review methodology with the data extraction forms to identify relevant information from the eligible RCTs. An evaluation of risk of bias, reporting quality and the combined effect of behavior change techniques and physical activity intervention components was performed. Results: Of 732 studies and after reviewing full text for 31, a total of seven studies met inclusion criteria. Two studies included explicit behavioral theories: Rogers´ science of unitary human beings (constructs: hope, power) and Social Cognitive Theory (self-efficacy, outcome expectations). The remaining five used behavior change strategies without any particular theory as a framework. Of behavior change techniques, social support and self-regulation combined with low intensity aerobic training in a supervised setting were associated with improved length of hospital stay, anxiety, depression functional walking capacity and health related quality of life. Discussion: Although most prehabilitation studies failed to report any theory-derived mechanisms of change or techniques, those that included theoretical models with relevant behavior change techniques improved delivery and receipt of physical activity interventions prior to elective surgery, with implications for more effective long term outcomes and permanent behavior change.