Integrating Telerehabilitation into the Prehabilitation and Rehabilitation Pathway in Colorectal Cancer: A Protocol for a Randomized Controlled Trial

IntroductionColorectal cancer (CRC) is a leading global malignancy, and surgery is frequently followed by complications, functional decline, and reduced quality of life. Multimodal prehabilitation and rehabilitation can improve physical recovery and psychosocial outcomes, but uptake is often limited by logistical and mobility barriers. Asynchronous telerehabilitation provides a flexible, patient-centred and scalable solution, yet its effectiveness across the perioperative CRC pathway has not been rigorously evaluated. This trial will test a multimodal asynchronous programme, delivered in prehabilitation and postoperative phases, against a standard leaflet-based approach. MethodsThis single-blind, parallel-group randomized controlled trial comparing an asynchronous, multimodal telerehabilitation program with a leaflet-based standard program in adults scheduled for elective CRC resection. Fifty-six participants will be randomized 1:1 to telerehabilitation (HEFORA platform) or control. The intervention spans a 2-week prehabilitation phase and a 4-week postoperative phase. Assessments occur at five time points: baseline (pre-prehabilitation), post-prehabilitation (pre-surgery), post-surgery (pre-rehabilitation), post-rehabilitation, and 3-month follow-up. OutcomesThe primary outcome is functional capacity (Six-Minute Walk Test distance). Secondary outcomes include muscle strength, body composition, pulmonary function, physical activity, sleep quality, psychosocial measures, health-related quality of life, treatment expectancy, usability, satisfaction, and adherence. Analyses will follow the intention-to-treat principle with appropriate models for repeated measures and sensitivity analyses for missing data and adherence. ConclusionsThis study will provide essential evidence on the role of asynchronous telerehabilitation in perioperative colorectal cancer management. Positive results could inform clinical guidelines, promote wider adoption of digital rehabilitation strategies, and drive a more accessible, patient-centered, and cost-effective approach to oncologic recovery. Trial registrationClinicalTrials.gov identifier: NCT06593678 Ethics approvalAragon Clinical Research Ethics Committee (PI23/557).