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Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis.
Physiotherapy 2014; 100(3):196-207P

Abstract

OBJECTIVE

To systematically review the evidence of pre-operative exercise, known as 'prehabilitation', on peri- and postoperative outcomes in adult surgical populations.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

CENTRAL, Medline, EMBASE, CINAHL, PsycINFO and PEDro were searched from 1950 to 2011.

METHODS

Two reviewers independently examined relevant, English-language articles that examined the effects of pre-operative total-body exercise with peri- and postoperative outcome analysis. Given the nascence of this field, controlled and uncontrolled trials were included. Risk of bias was assessed using the Cochrane Risk of Bias Assessment tool. Only data on length of stay were considered eligible for meta-analysis due to the heterogeneity of measures and methodologies for assessing other outcomes.

RESULTS

In total, 4597 citations were identified by the search strategy, of which 21 studies were included. Trials were generally small (median=54 participants) and of moderate to poor methodological quality. Compared with standard care, the majority of studies found that total-body prehabilitation improved postoperative pain, length of stay and physical function, but it was not consistently effective in improving health-related quality of life or aerobic fitness in the studies that examined these outcomes. The meta-analysis indicated that prehabilitation reduced postoperative length of stay with a small to moderate effect size (Hedges' g=-0.39, P=0.033). Intervention-related adverse events were reported in two of 669 exercising participants.

CONCLUSION

The literature provides early evidence that prehabilitation may reduce length of stay and possibly provide postoperative physical benefits. Cautious interpretation of these findings is warranted given modest methodological quality and significant risk of bias.

Authors+Show Affiliations

Department of Surgical Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Kinesiology Program, University of Guelph-Humber, Toronto, Ontario, Canada; School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada. Electronic address: Daniel.santamina@guelphhumber.ca.University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada.Kinesiology Program, University of Guelph-Humber, Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada.University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada.Department of Surgical Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada.Department of Surgical Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

24439570

Citation

Santa Mina, D, et al. "Effect of Total-body Prehabilitation On Postoperative Outcomes: a Systematic Review and Meta-analysis." Physiotherapy, vol. 100, no. 3, 2014, pp. 196-207.
Santa Mina D, Clarke H, Ritvo P, et al. Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy. 2014;100(3):196-207.
Santa Mina, D., Clarke, H., Ritvo, P., Leung, Y. W., Matthew, A. G., Katz, J., ... Alibhai, S. M. (2014). Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy, 100(3), pp. 196-207. doi:10.1016/j.physio.2013.08.008.
Santa Mina D, et al. Effect of Total-body Prehabilitation On Postoperative Outcomes: a Systematic Review and Meta-analysis. Physiotherapy. 2014;100(3):196-207. PubMed PMID: 24439570.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. AU - Santa Mina,D, AU - Clarke,H, AU - Ritvo,P, AU - Leung,Y W, AU - Matthew,A G, AU - Katz,J, AU - Trachtenberg,J, AU - Alibhai,S M H, Y1 - 2013/11/13/ PY - 2013/04/24/received PY - 2013/08/23/accepted PY - 2014/1/21/entrez PY - 2014/1/21/pubmed PY - 2015/4/22/medline KW - Exercise KW - General surgery KW - Meta-analysis KW - Postoperative outcomes KW - Postoperative period KW - Pre-operative exercise KW - Prehabilitation KW - Preoperative care KW - Preoperative period KW - Rehabilitation KW - Systematic review SP - 196 EP - 207 JF - Physiotherapy JO - Physiotherapy VL - 100 IS - 3 N2 - OBJECTIVE: To systematically review the evidence of pre-operative exercise, known as 'prehabilitation', on peri- and postoperative outcomes in adult surgical populations. DESIGN: Systematic review and meta-analysis. DATA SOURCES: CENTRAL, Medline, EMBASE, CINAHL, PsycINFO and PEDro were searched from 1950 to 2011. METHODS: Two reviewers independently examined relevant, English-language articles that examined the effects of pre-operative total-body exercise with peri- and postoperative outcome analysis. Given the nascence of this field, controlled and uncontrolled trials were included. Risk of bias was assessed using the Cochrane Risk of Bias Assessment tool. Only data on length of stay were considered eligible for meta-analysis due to the heterogeneity of measures and methodologies for assessing other outcomes. RESULTS: In total, 4597 citations were identified by the search strategy, of which 21 studies were included. Trials were generally small (median=54 participants) and of moderate to poor methodological quality. Compared with standard care, the majority of studies found that total-body prehabilitation improved postoperative pain, length of stay and physical function, but it was not consistently effective in improving health-related quality of life or aerobic fitness in the studies that examined these outcomes. The meta-analysis indicated that prehabilitation reduced postoperative length of stay with a small to moderate effect size (Hedges' g=-0.39, P=0.033). Intervention-related adverse events were reported in two of 669 exercising participants. CONCLUSION: The literature provides early evidence that prehabilitation may reduce length of stay and possibly provide postoperative physical benefits. Cautious interpretation of these findings is warranted given modest methodological quality and significant risk of bias. SN - 1873-1465 UR - https://www.unboundmedicine.com/medline/citation/24439570/Effect_of_total_body_prehabilitation_on_postoperative_outcomes:_a_systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0031-9406(13)00114-4 DB - PRIME DP - Unbound Medicine ER -