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Prehabilitation may reduce adverse events and improve postoperative recovery. This study aimed to investigate the facilitators and barriers to participation in prehabilitation prior to elective surgery from the perspective of elderly (pre-)frail patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This qualitative study was nested within the PRAEP-GO trial, a multicentre randomised controlled trial currently investigating the (cost-)effectiveness of multimodal prehabilitation for elderly (pre-)frail patients in Germany. From February to April 2023, semi-structured face-to-face interviews were conducted with patients allocated to the intervention group of the PRAEP-GO trial. After verbatim transcription of the interviews, data were analysed using content-structuring qualitative content analysis. Results were synthesised using the capability, opportunity, motivation and behaviour (COM-B) model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eight patients with a mean age of 78.5 \u00b1 3 years were interviewed in their homes. All interviewees had an indication for an orthopaedic surgery and had participated in the prehabilitation programme offered within the PRAEP-GO trial. In total, 32 facilitators and 25 barriers to participation were identified. These could be assigned to the entire spectrum of the COM-B model. The focus on individual needs, personalised advice from healthcare professionals and a well-organised prehabilitation programme facilitated participation in prehabilitation. Gaps in knowledge, limited physical functioning, (co-)morbidities and an inflexible attitude were identified as barriers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These insights from the elderly (pre-)frail patient\u2019s perspective are an essential addition to the quantitative data generated in prehabilitation trials. The identified facilitators and barriers should be considered in the future implementation of prehabilitation programmes for this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>PRAEP-GO trial: ClinicalTrials.gov (NCT04418271; June 1, 2020), Qualitative study: Open Science Framework Registries (osf.io\/xnbqc; February 18, 2023).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12877-025-06592-3","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T11:50:33Z","timestamp":1762257033000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Facilitators and barriers to participation in prehabilitation prior to orthopaedic elective surgery \u2013 a qualitative study with elderly (pre-)frail patients"],"prefix":"10.1186","volume":"25","author":[{"given":"Carina","family":"Sch\u00f6ne","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamina I.","family":"Fuchs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rn","family":"Kiselev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan J.","family":"Schaller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Spies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanja","family":"Rombey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,4]]},"reference":[{"key":"6592_CR1","unstructured":"Statistisches Bundesamt (Destatis). 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For the present qualitative study, additional ethical approval was obtained from the ethics committee of Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin (EA1\/272\/22 dated 1 February 2023). All participants were transparently informed in advance about the qualitative study and the data protection regulations. Written informed consent was obtained before the interviews were conducted.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"CSc performed the research as part of her master\u2019s thesis and declared no financial conflict of interest. TIF declares no financial conflict of interest. JK, KS, SJS, CSp and TR are involved in an ongoing randomised clinical trial on prehabilitation in the frail elderly (PRAEP-GO; ClinicalTrials.gov identifier NCT04418271) funded by the Innovationsfonds des Gemeinsamen Bundesausschusses. JK and KS declare no financial conflict of interest.SJS received grants and non-financial support from Reactive Robotics GmbH (Munich, Germany), ASP GmbH (Attendorn, Germany), STIMIT AG (Biel, Switzerland), ESICM (Geneva, Switzerland), grants, personal fees and non-financial support from Fresenius Kabi Deutschland GmbH (Bad Homburg, Germany), grants from the Innovationsfond of The Federal Joint Committee (G-BA), personal fees from Springer Verlag GmbH (Vienna, Austria) for educational purposes and Advanz Pharma GmbH (Bielefeld, Germany), non-financial support from national and international societies (and their congress organisers) in the field of anesthesiology and intensive care medicine, outside the submitted work. SJS holds stocks in small amounts from Alphabeth Inc., Bayer AG and Siemens AG; these holdings have not affected any decisions regarding his research or this study.CSp reports grants from Innovationsfonds des Gemeinsamen Bundesausschusses, Bundesministerium f\u00fcr Bildung und Forschung, Bundesministerium f\u00fcr Gesundheit\/Robert Koch-Institut, Deutsche Forschungsgemeinschaft, Deutsches Zentrum f\u00fcr Luft- und Raumfahrt e. V., Einstein Stiftung Berlin, Inneruniversit\u00e4re Forschungsf\u00f6rderung, European Society of Anaesthesiology and Intensive Care, Baxter Deutschland GmbH, Cytosorbents Europe GmbH, Edwards Lifesciences Germany GmbH, Fresenius Medical Care, Gr\u00fcnenthal GmbH, Masimo Europe Ltd., Pfizer Pharma GmbH, Dr. F. K\u00f6hler Chemie GmbH, Sintetica GmbH, Stifterverband f\u00fcr die deutsche Wissenschaft e.V.\/Phillips, Stiftung Charit\u00e9, AGUETTANT Deutschland GmbH, AbbVie Deutschland GmbH & Co. KG, Amomed Pharma GmbH, InTouch Health, Copra System GmbH, Correvio GmbH, Max-Planck-Gesellschaft zur F\u00f6rderung der Wissenschaften e.V., Deutsche Gesellschaft f\u00fcr An\u00e4sthesiologie & Intensivmedizin, Stifterverband f\u00fcr die deutsche Wissenschaft e.V.\/Metronic, Philips Electronics Nederland BV, Dr\u00e4gerwerk AG & Co. KGaA; personal fees from Georg Thieme Verlag, all outside the submitted work.TR received honorary fees for commissioned research by the Statutory Health Insurance Medical Review Board outside the submitted work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"845"}}