Standards for reporting research methods, interventions, and Outcomes in Surgical Prehabilitation studies (SOS-Prehab)

Surgery is a planned trauma with a predictable stress response1. Yet patients are routinely sent to the operating room without preparation for the physiological demands of major surgery. Prehabilitation seeks to change this paradigm by strengthening patients’ physiological reserve before surgery through targeted interventions such as exercise training, nutritional optimization, and psychological support2.

Interest in prehabilitation has grown rapidly over the past decade. Randomized trials and evidence syntheses suggest that these interventions may improve both patient-oriented and clinician-oriented outcomes3, 4. However, despite these encouraging findings, translation into routine surgical care remains challenging. This is partially because the field still requires larger, more definitive trials to guide implementation, but designing and interpreting such trials depends on clear and transparent reporting of the interventions being studied.

Too often, prehabilitation trials do not adequately describe what their interventions actually involve5. Previous literature reviews have shown that studies report only about half of the items recommended in existing intervention-reporting frameworks, limiting the interpretability and reproducibility of their findings6.

This issue is particularly important in prehabilitation research because the interventions themselves are inherently complex7. Programmes frequently combine multiple modalities, including exercise, nutrition, and behavioural support, delivered in different settings and with varying levels of supervision and personalization. When these elements are incompletely reported, clinicians and researchers cannot determine what was actually tested, how the intervention was delivered, or why it may or may not have worked.

Without this information, clinicians cannot determine whether an intervention was ineffective or simply poorly implemented8. Equally important, researchers cannot identify which elements of prehabilitation drive clinical benefit or which require further refinement.

To address this challenge, we developed the Standards for reporting research methods, interventions, and Outcomes in Surgical Prehabilitation studies (SOS-Prehab)9, a reporting checklist specifically designed for randomized trials evaluating prehabilitation.

The checklist was developed through a modified Delphi consensus process involving 53 international experts in prehabilitation from perioperative medicine, exercise science, nutrition, and psychology. Candidate items were derived from a scoping review and existing reporting frameworks6 and were refined through two Delphi rounds.

The final checklist contains 40 reporting items, including 16 essential items and 24 important items, covering critical aspects of prehabilitation interventions. These include:

SOS-Prehab is intended to complement existing reporting standards such as CONSORT10 by focusing specifically on the elements of intervention design and delivery that are unique to prehabilitation.

For surgeons evaluating new perioperative strategies, incomplete trial reporting creates uncertainty. When a trial concludes that “prehabilitation improved outcomes,” the key question remains: what exactly did the intervention involve?

More specifically, was the benefit driven by structured aerobic training, resistance exercise, nutritional supplementation, behavioural support to improve adherence, or some combination of these components? Was the programme supervised, home-based, or hybrid? Was it delivered by healthcare professionals or trained coaches? And were interventions tailored to baseline patient characteristics or delivered as a standardized protocol?

These details matter. Without them, clinicians cannot judge whether a programme is feasible within their own practice environment or applicable to their patient population.

Clear reporting is also essential for evidence synthesis. Meta-analyses, which are often used to inform clinical guidelines and perioperative care pathways, rely on accurate descriptions of interventions to estimate treatment effects, explore heterogeneity, and determine which components are most effective. When reporting is inconsistent, it becomes difficult to refine prehabilitation strategies and translate evidence into targeted, patient-centred perioperative care.

Prehabilitation research is entering a new phase. Future studies must move beyond the simple question of whether prehabilitation works and instead address more nuanced issues: which patients benefit most, who requires multimodal versus unimodal interventions, who benefits from intensive supervised programmes versus home-based approaches, and how these programmes can be implemented efficiently within surgical pathways.

Achieving these goals requires not only rigorous trials but also transparent and standardized reporting. By providing a consensus-based framework for reporting prehabilitation interventions, the SOS-Prehab checklist aims to enhance interpretation of trial findings, improve reproducibility, strengthen evidence synthesis, and accelerate translation of effective prehabilitation programmes into clinical practice.

For a complex and multidisciplinary intervention such as prehabilitation, better reporting is not simply a methodological refinement; it is a prerequisite for ensuring that the right patients receive the right care at the right time.