{"id":{"repo_id":"oxford-brookes","oai_identifier":"tle:7675052c-826c-474d-bef5-f13d2d6ced5b:d6bd9758-527a-46cd-bfe2-c433766e8fca:1"},"canonical_url":"https://search.dev.ndltd.org/etd/oxford-brookes/tle:7675052c-826c-474d-bef5-f13d2d6ced5b:d6bd9758-527a-46cd-bfe2-c433766e8fca:1","repository":{"repo_id":"oxford-brookes","name":"Oxford Brookes University","base_url":"https://radar.brookes.ac.uk/radar/oai"},"display":{"title":"Cancer prehabilitation: Developing a complex intervention for patients undergoing upper gastrointestinal surgery","abstract":"Prehabilitation is recommended to improve surgical patient outcomes, but is not offered routinely in upper gastrointestinal centres across the United Kingdom. Where prehabilitation is offered, the delivery, and approaches to how it’s delivered and funded are not standardised, resulting in inequity of access and variability in patient outcomes. This thesis explores and identifies best practice components to inform the development of a complex prehabilitation intervention for patients undergoing upper gastrointestinal surgery. To map and synthesise the current and available evidence for the effectiveness of prehabilitation interventions on biopsychosocial and service outcomes for patients undergoing upper gastrointestinal surgery, a systematic review was conducted. Following database searches, 6028 deduplicated records were screened. Prospective experimental studies exploring prehabilitation interventions in adults undergoing upper gastrointestinal surgery were eligible with 25 studies (from 26 reports) included in the review. The prehabilitation interventions across the studies were grouped into inspiratory muscle training (five studies n=450); exercise (nine studies n=683); psychological (one study n=400); and nutritional (ten studies n=487). Study quality was assessed using the Cochrane risk of bias tool (v.2). Data synthesis was narrative (SWiM guidance). The results confirmed a lack of robust, adequately powered clinical trials to inform intervention delivery. High quality studies showed preoperative improvements in directly targeted impairments, but generally these did not translate into functional or postoperative benefits. Included studies that combined more than one intervention showed greater promise of increased efficacy, particularly when exercise was combined with nutritional and/or psychological interventions, which supports the concept of a multimodal multidisciplinary approach in future prehabilitation intervention design. Patient perspectives of exercise and physical activity were captured through a qualitative study where four patients undergoing surgery for urological cancer management were interviewed. Thematic analysis of the interview transcripts revealed the complexity of individual experiences of patients undergoing surgery, emphasising a need for shared patient goals across the healthcare team to enhance individual tailoring of interventions and optimise behaviour change. The potential role for supportive technology and the need for multidisciplinary training for healthcare professionals was evident, with transferable concepts and insights for all prehabilitation interventions, including patients undergoing upper gastrointestinal surgery. A service evaluation exploring the effects of existing preoperative interventions on postoperative outcomes in 632 patients undergoing upper gastrointestinal surgery was conducted at a local centre over a four-year period. The results broadly demonstrated some useful insights regarding the acceptability of optional supervised exercise from a patient perspective. The use of low intensity preoperative inspiratory muscle training did not improve postoperative outcomes in this service. A stakeholder consensus study, utilising a modified nominal group technique approach, combined existing evidence and insight from the previous three studies with expert opinion to establish key priorities for prehabilitation intervention development. The stakeholder panel (n=8) included physiotherapists, dietitians with experience in prehabilitation, as well as an experienced patient advocate. This study achieved a high level of consensus across many aspects of prehabilitation, with eight out of 89 ideas achieving 100% consensus agreement (9%) and 31 out of 89 ideas achieving consensus of 71% or higher (35%). The main findings demonstrated complete consensus that prehabilitation should be delivered as a multimodal, multidisciplinary intervention that combines all three core aspects (exercise, nutrition and psychological support) for patients undergoing upper gastrointestinal surgery. Together, the findings from these four studies provide the basis for the development of a prehabilitation intervention for patients undergoing upper gastrointestinal surgery. The intervention would need further development with relevant stakeholder representation ready for refinement and feasibility testing, prior to clinical implementation, but provides valuable insights for those currently developing or delivering prehabilitation services for patients undergoing upper gastrointestinal surgery in the United Kingdom.","abstract_html":"Prehabilitation is recommended to improve surgical patient outcomes, but is not offered routinely in upper gastrointestinal centres across the United Kingdom. Where prehabilitation is offered, the delivery, and approaches to how it’s delivered and funded are not standardised, resulting in inequity of access and variability in patient outcomes. This thesis explores and identifies best practice components to inform the development of a complex prehabilitation intervention for patients undergoing upper gastrointestinal surgery. To map and synthesise the current and available evidence for the effectiveness of prehabilitation interventions on biopsychosocial and service outcomes for patients undergoing upper gastrointestinal surgery, a systematic review was conducted. Following database searches, 6028 deduplicated records were screened. Prospective experimental studies exploring prehabilitation interventions in adults undergoing upper gastrointestinal surgery were eligible with 25 studies (from 26 reports) included in the review. The prehabilitation interventions across the studies were grouped into inspiratory muscle training (five studies n=450); exercise (nine studies n=683); psychological (one study n=400); and nutritional (ten studies n=487). Study quality was assessed using the Cochrane risk of bias tool (v.2). Data synthesis was narrative (SWiM guidance). The results confirmed a lack of robust, adequately powered clinical trials to inform intervention delivery. High quality studies showed preoperative improvements in directly targeted impairments, but generally these did not translate into functional or postoperative benefits. Included studies that combined more than one intervention showed greater promise of increased efficacy, particularly when exercise was combined with nutritional and/or psychological interventions, which supports the concept of a multimodal multidisciplinary approach in future prehabilitation intervention design. Patient perspectives of exercise and physical activity were captured through a qualitative study where four patients undergoing surgery for urological cancer management were interviewed. Thematic analysis of the interview transcripts revealed the complexity of individual experiences of patients undergoing surgery, emphasising a need for shared patient goals across the healthcare team to enhance individual tailoring of interventions and optimise behaviour change. The potential role for supportive technology and the need for multidisciplinary training for healthcare professionals was evident, with transferable concepts and insights for all prehabilitation interventions, including patients undergoing upper gastrointestinal surgery. A service evaluation exploring the effects of existing preoperative interventions on postoperative outcomes in 632 patients undergoing upper gastrointestinal surgery was conducted at a local centre over a four-year period. The results broadly demonstrated some useful insights regarding the acceptability of optional supervised exercise from a patient perspective. The use of low intensity preoperative inspiratory muscle training did not improve postoperative outcomes in this service. A stakeholder consensus study, utilising a modified nominal group technique approach, combined existing evidence and insight from the previous three studies with expert opinion to establish key priorities for prehabilitation intervention development. The stakeholder panel (n=8) included physiotherapists, dietitians with experience in prehabilitation, as well as an experienced patient advocate. This study achieved a high level of consensus across many aspects of prehabilitation, with eight out of 89 ideas achieving 100% consensus agreement (9%) and 31 out of 89 ideas achieving consensus of 71% or higher (35%). The main findings demonstrated complete consensus that prehabilitation should be delivered as a multimodal, multidisciplinary intervention that combines all three core aspects (exercise, nutrition and psychological support) for patients undergoing upper gastrointestinal surgery. Together, the findings from these four studies provide the basis for the development of a prehabilitation intervention for patients undergoing upper gastrointestinal surgery. The intervention would need further development with relevant stakeholder representation ready for refinement and feasibility testing, prior to clinical implementation, but provides valuable insights for those currently developing or delivering prehabilitation services for patients undergoing upper gastrointestinal surgery in the United Kingdom.","abstract_has_math":false,"creators":["Stiger, Robyn Jane"],"institution":"Oxford Brookes University","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":["Collett, Johnny","Williams, Mark"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":null,"date_issued":"","date_published":null,"updated_at":"2026-07-24T03:42:31Z","subjects":[],"languages":["en"],"rights":["All rights reserved"],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://doi.org/10.24384/z81n-6872","outbound_label":"DOI","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Collett, Johnny","Williams, Mark","Stiger, Robyn Jane"]},{"key":"dc:creator","label":"Author","values":["Stiger, Robyn Jane"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:publisher","label":"Institution","values":["Oxford Brookes University"]},{"key":"dc:type","label":"Dc Type","values":["thesis"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["en"]},{"key":"dc:rights","label":"Dc Rights","values":["All rights reserved"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://doi.org/10.24384/z81n-6872","https://radar.brookes.ac.uk/radar/file/7675052c-826c-474d-bef5-f13d2d6ced5b/1/Robyn Stiger - Final Thesis ammendments 210125.pdf"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["Prehabilitation is recommended to improve surgical patient outcomes, but is not offered routinely in upper gastrointestinal centres across the United Kingdom. Where prehabilitation is offered, the delivery, and approaches to how it’s delivered and funded are not standardised, resulting in inequity of access and variability in patient outcomes. This thesis explores and identifies best practice components to inform the development of a complex prehabilitation intervention for patients undergoing upper gastrointestinal surgery. To map and synthesise the current and available evidence for the effectiveness of prehabilitation interventions on biopsychosocial and service outcomes for patients undergoing upper gastrointestinal surgery, a systematic review was conducted. Following database searches, 6028 deduplicated records were screened. Prospective experimental studies exploring prehabilitation interventions in adults undergoing upper gastrointestinal surgery were eligible with 25 studies (from 26 reports) included in the review. The prehabilitation interventions across the studies were grouped into inspiratory muscle training (five studies n=450); exercise (nine studies n=683); psychological (one study n=400); and nutritional (ten studies n=487). Study quality was assessed using the Cochrane risk of bias tool (v.2). Data synthesis was narrative (SWiM guidance). The results confirmed a lack of robust, adequately powered clinical trials to inform intervention delivery. High quality studies showed preoperative improvements in directly targeted impairments, but generally these did not translate into functional or postoperative benefits. Included studies that combined more than one intervention showed greater promise of increased efficacy, particularly when exercise was combined with nutritional and/or psychological interventions, which supports the concept of a multimodal multidisciplinary approach in future prehabilitation intervention design. Patient perspectives of exercise and physical activity were captured through a qualitative study where four patients undergoing surgery for urological cancer management were interviewed. Thematic analysis of the interview transcripts revealed the complexity of individual experiences of patients undergoing surgery, emphasising a need for shared patient goals across the healthcare team to enhance individual tailoring of interventions and optimise behaviour change. The potential role for supportive technology and the need for multidisciplinary training for healthcare professionals was evident, with transferable concepts and insights for all prehabilitation interventions, including patients undergoing upper gastrointestinal surgery. A service evaluation exploring the effects of existing preoperative interventions on postoperative outcomes in 632 patients undergoing upper gastrointestinal surgery was conducted at a local centre over a four-year period. The results broadly demonstrated some useful insights regarding the acceptability of optional supervised exercise from a patient perspective. The use of low intensity preoperative inspiratory muscle training did not improve postoperative outcomes in this service. A stakeholder consensus study, utilising a modified nominal group technique approach, combined existing evidence and insight from the previous three studies with expert opinion to establish key priorities for prehabilitation intervention development. The stakeholder panel (n=8) included physiotherapists, dietitians with experience in prehabilitation, as well as an experienced patient advocate. This study achieved a high level of consensus across many aspects of prehabilitation, with eight out of 89 ideas achieving 100% consensus agreement (9%) and 31 out of 89 ideas achieving consensus of 71% or higher (35%). The main findings demonstrated complete consensus that prehabilitation should be delivered as a multimodal, multidisciplinary intervention that combines all three core aspects (exercise, nutrition and psychological support) for patients undergoing upper gastrointestinal surgery. Together, the findings from these four studies provide the basis for the development of a prehabilitation intervention for patients undergoing upper gastrointestinal surgery. The intervention would need further development with relevant stakeholder representation ready for refinement and feasibility testing, prior to clinical implementation, but provides valuable insights for those currently developing or delivering prehabilitation services for patients undergoing upper gastrointestinal surgery in the United Kingdom."]},{"key":"dc:format","label":"Dc Format","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["Cancer prehabilitation: Developing a complex intervention for patients undergoing upper gastrointestinal surgery"]}]}],"canonical_facts":{"dc:contributor":["Collett, Johnny","Williams, Mark","Stiger, Robyn Jane"],"dc:creator":["Stiger, Robyn Jane"],"dc:description":["Prehabilitation is recommended to improve surgical patient outcomes, but is not offered routinely in upper gastrointestinal centres across the United Kingdom. Where prehabilitation is offered, the delivery, and approaches to how it’s delivered and funded are not standardised, resulting in inequity of access and variability in patient outcomes. This thesis explores and identifies best practice components to inform the development of a complex prehabilitation intervention for patients undergoing upper gastrointestinal surgery. To map and synthesise the current and available evidence for the effectiveness of prehabilitation interventions on biopsychosocial and service outcomes for patients undergoing upper gastrointestinal surgery, a systematic review was conducted. Following database searches, 6028 deduplicated records were screened. Prospective experimental studies exploring prehabilitation interventions in adults undergoing upper gastrointestinal surgery were eligible with 25 studies (from 26 reports) included in the review. The prehabilitation interventions across the studies were grouped into inspiratory muscle training (five studies n=450); exercise (nine studies n=683); psychological (one study n=400); and nutritional (ten studies n=487). Study quality was assessed using the Cochrane risk of bias tool (v.2). Data synthesis was narrative (SWiM guidance). The results confirmed a lack of robust, adequately powered clinical trials to inform intervention delivery. High quality studies showed preoperative improvements in directly targeted impairments, but generally these did not translate into functional or postoperative benefits. Included studies that combined more than one intervention showed greater promise of increased efficacy, particularly when exercise was combined with nutritional and/or psychological interventions, which supports the concept of a multimodal multidisciplinary approach in future prehabilitation intervention design. Patient perspectives of exercise and physical activity were captured through a qualitative study where four patients undergoing surgery for urological cancer management were interviewed. Thematic analysis of the interview transcripts revealed the complexity of individual experiences of patients undergoing surgery, emphasising a need for shared patient goals across the healthcare team to enhance individual tailoring of interventions and optimise behaviour change. The potential role for supportive technology and the need for multidisciplinary training for healthcare professionals was evident, with transferable concepts and insights for all prehabilitation interventions, including patients undergoing upper gastrointestinal surgery. A service evaluation exploring the effects of existing preoperative interventions on postoperative outcomes in 632 patients undergoing upper gastrointestinal surgery was conducted at a local centre over a four-year period. The results broadly demonstrated some useful insights regarding the acceptability of optional supervised exercise from a patient perspective. The use of low intensity preoperative inspiratory muscle training did not improve postoperative outcomes in this service. A stakeholder consensus study, utilising a modified nominal group technique approach, combined existing evidence and insight from the previous three studies with expert opinion to establish key priorities for prehabilitation intervention development. The stakeholder panel (n=8) included physiotherapists, dietitians with experience in prehabilitation, as well as an experienced patient advocate. This study achieved a high level of consensus across many aspects of prehabilitation, with eight out of 89 ideas achieving 100% consensus agreement (9%) and 31 out of 89 ideas achieving consensus of 71% or higher (35%). The main findings demonstrated complete consensus that prehabilitation should be delivered as a multimodal, multidisciplinary intervention that combines all three core aspects (exercise, nutrition and psychological support) for patients undergoing upper gastrointestinal surgery. Together, the findings from these four studies provide the basis for the development of a prehabilitation intervention for patients undergoing upper gastrointestinal surgery. The intervention would need further development with relevant stakeholder representation ready for refinement and feasibility testing, prior to clinical implementation, but provides valuable insights for those currently developing or delivering prehabilitation services for patients undergoing upper gastrointestinal surgery in the United Kingdom."],"dc:format":["application/pdf"],"dc:identifier":["https://doi.org/10.24384/z81n-6872","https://radar.brookes.ac.uk/radar/file/7675052c-826c-474d-bef5-f13d2d6ced5b/1/Robyn Stiger - Final Thesis ammendments 210125.pdf"],"dc:language":["en"],"dc:publisher":["Oxford Brookes University"],"dc:rights":["All rights reserved"],"dc:title":["Cancer prehabilitation: Developing a complex intervention for patients undergoing upper gastrointestinal surgery"],"dc:type":["thesis"]},"updated_at":"2026-07-24T03:42:31Z"}