The Effect of Unimodal, Non-pharmacological, Preoperative Psychological Prehabilitation Interventions on Preoperative Anxiety and Stress: A Systematic Review

Background: Prehabilitation is a novel clinical strategy to optimize patients’ health in the waiting period before surgery. Objectives: This article aims to gather the evidence for the effectiveness of unimodal, non-pharmacological psychological prehabilitation interventions on preoperative anxiety and stress before surgery. Design: This is a PRISMA-guided systematic review and narrative synthesis of randomized controlled trials. Methods: The online databases Medline, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, PsycINFO and Google Scholar were searched on March 20th 2023. The search strategy led to 13,667 records screened and five records of randomized controlled trials included for full-text analysis. A risk-of-bias assessment was performed using the Revised Cochrane Risk of Bias 2 tool. Results: Significant reduction in preoperative anxiety was seen in three studies comprising 337 participants. Two studies did not find that unimodal psychological prehabilitation reduces preoperative anxiety. Only one study assessed preoperative stress and reported a significant reduction. Intervention types used included guided imagery, stress management training, virtual reality experience and computer cognitive behavioral therapy. Conclusions: There is contradictory evidence whether unimodal, non-pharmacological psychological prehabilitation can reduce preoperative anxiety. There is little evidence that non-pharmacological prehabilitation can reduce preoperative stress. Suggestions to improve the research in this field are discussed.