Psychological prehabilitation

Prehabilitation is a targeted, evidence-based, and multidisciplinary process implemented during the period between diagnosis and a planned surgical or other medical intervention. Its goal is to improve the patient's functional capacity, physiological reserves, and psychological resilience in order to enhance the body's ability to withstand the stress of treatment, reduce the risk of postoperative complications, and facilitate a faster and more successful recovery. In modern practice, prehabilitation encompasses one or more interventions—such as exercise programs, nutritional optimization, breathing exercises, and psychological strategies—that are tailored to the patient's specific needs and health status.

Prehabilitation is based on the concept that a patient's functional status prior to surgery is a key determinant of the postoperative recovery process. The greater the patient's physiological and psychological reserves before treatment, the more effectively the body can adapt to the physiological stress induced by surgery. Consequently, prehabilitation is considered a proactive approach to perioperative care; rather than focusing on treating complications after they arise, it prioritizes their prevention by strengthening the patient's resources before treatment begins. Studies indicate that prehabilitation has a positive impact on patients' physical health. Regular physical activity and nutritional optimization prior to surgery improve cardiopulmonary capacity, muscle strength, physical endurance, and functional abilities, while also reducing the incidence of postoperative complications and the length of hospital stays. Results from systematic reviews and meta-analyses show that multimodal programs—combining physical activity with nutritional and psychological interventions—are the most effective.

Alongside physical benefits, increasing attention is being paid to psychological prehabilitation. Psychological interventions include psychoeducation, anxiety and stress reduction methods, relaxation and mindfulness techniques, sleep quality improvement, and the strengthening of self-efficacy and motivation. The aim of these interventions is to foster the patient's active involvement in the treatment process and to encourage behavioral changes beneficial to health.

Evidence indicates that lower preoperative anxiety and better psychological preparedness are associated with reduced postoperative pain intensity, improved emotional well-being, higher adherence to the rehabilitation process, and more successful functional recovery. Improving sleep quality is particularly important, as sleep difficulties are a factor linked to prolonged postoperative pain and slower recovery.

Individualized psychological preparation focused on improving sleep quality and promoting behavioral change helps patients better prepare for surgery, strengthens their self-efficacy, and fosters adaptive behavior during the postoperative period. The study highlights the significant role of the health psychologist within a multidisciplinary prehabilitation team.

Although the concepts of prehabilitation and rehabilitation are closely linked, they refer to distinct stages of the treatment process. Prehabilitation is implemented prior to surgery or other medical interventions and aims to strengthen the patient's reserves, whereas rehabilitation begins after surgery, injury, or the acute phase of an illness, focusing on restoring lost functions, minimizing complications, and facilitating the patient's return to daily life. Thus, prehabilitation is a proactive and preventive approach, while rehabilitation is a therapeutic and restorative one. In modern perioperative care, both are considered complementary components of the continuous patient care process.

Literature

de Loughry, G., & Sherwin, A. (2026). Prehabilitation. Anaesthesia & Intensive Care Medicine, 27(7), 406–412. https://doi.org/10.1016/j.mpaic.2026.05.003

Fleurent-Grégoire, et al. (2024). Towards a common definition of surgical prehabilitation: A scoping review of randomised trials. British Journal of Anaesthesia, 133(2), 305–315. https://doi.org/10.1016/j.bja.2024.02.035

McIsaac, D. I., Gillis, C., Hladkowicz, E., et al. (2025). Relative efficacy of prehabilitation interventions and their components: Systematic review with network and component network meta-analyses of randomised controlled trials. BMJ, 388, e081164. https://doi.org/10.1136/bmj-2024-081164

Shi, G., Xu, H., Tang, X., Ding, Q., Tong, Y., Xu, Y., & Pan, H. (2026). Preoperative prehabilitation in adults: A concept analysis. International Journal of Nursing Studies Advances, 10, 100565. https://doi.org/10.1016/j.ijnsa.2026.100565

Tidmarsh, L. V., Harrison, R., & Finlay, K. A. (2024). Prehabilitation: The underutilised weapon for chronic pain management. British journal of pain, 18(4), 354–364. https://doi.org/10.1177/20494637241250239

Whale, K., Johnson, E., & Gooberman-Hill, R. (2025). The role of health psychology in surgical prehabilitation: Insights from REST, a preoperative sleep intervention for total knee replacement patients. Musculoskeletal Care, 23(2), e70088. https://doi.org/10.1002/msc.70088