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The effectiveness of prehabilitation or preoperative exercise for surgical patients: a systematic review.

Abstract

BACKGROUND

Major surgery can induce functional decline and pain, which can also have negative implications on health care utilization and quality of life. Prehabilitation is the process of optimizing physical functionality preoperatively to enable the individual to maintain a normal level of function during and after surgery. Prehabilitation training can be a combination of aerobic exercises, strength training, and functional task training to suit individual needs.

OBJECTIVES

To evaluate the impact of prehabilitation on physical functional status, health care utilization, quality of life, and pain after surgery.

INCLUSION CRITERIA

Studies of adult surgical patients, excluding day surgery patients.Any preoperative exercise interventions identified in the study as part of a prehabilitation or preoperative exercise program, versus usual care.Randomized controlled trials.Functional status, health care utilization, quality of life and pain.

SEARCH STRATEGY

Published (CINAHL, CENTRAL, EMBASE, MEDLINE, PEDro) and unpublished studies between 1996 and March 2013 were searched extensively.

METHODOLOGICAL QUALITY

All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality.

DATA COLLECTION

Data from included papers were extracted using a modified data extraction tool.

DATA SYNTHESIS

Where possible, study results were pooled in statistical meta-analysis. Alternatively, results are presented in narrative and table form.

RESULTS

A total of 3167 citations were identified; after removal of duplicates, assessment for relevance and eligibility, 33 studies underwent critical appraisal. Seventeen studies met the quality criteria and were included in quantitative synthesis. Thirteen studies were conducted in orthopedics (mainly knee or hip arthroplasty for osteoarthritis), one in colorectal, two in cardiac and one in upper gastrointestinal/hepatobiliary. Function, pain and quality of life were quantified according to prehabilitation dose and postoperative months. Prehabilitation, at any dose, did not demonstrate benefits in objective and self-reported function at any of the postoperative time points. Prehabilitation did not demonstrate benefits in quality of life or pain; however, there was significant evidence that prehabilitation doses of more than 500 minutes reduced the need for postoperative rehabilitation, but no significant reduction was found in readmissions or nursing home placement.

CONCLUSIONS

Results from this review reveal that prehabilitation has no significant postoperative benefits in function, quality of life and pain in patients who have had knee or hip arthroplasty for osteoarthritis; however, there is evidence that prehabilitation may reduce admission to rehabilitation in this population. The evidence on postoperative benefits of prehabilitation in other surgical populations is limited; however, preliminary evidence does not demonstrate better outcomes.

IMPLICATIONS FOR PRACTICE

There is no evidence that prehabilitation provides benefits in function, pain or quality of life in patients who have had arthroplasty for osteoarthritis; however prehabilitation doses of more than 500 minutes might reduce acute rehabilitation admissions. The evidence is insufficient to provide recommendations on the benefits of prehabilitation in other surgical populations.

IMPLICATIONS FOR RESEARCH

Future prehabilitation studies are not recommended in patients with osteoarthritis for whom arthroplasty is planned. However, should prehabilitation be tested in other surgical populations, programs must consider patient suitability, setting, delivery of intervention and clinical effectiveness. It is also recommended that the exercises prescribed should be maintained and adhered to after surgery. Most importantly, prehabilitation studies must have adequately powered sample sizes.

Authors+Show Affiliations

1 Nursing Research Centre, Mater Health Services; Nursing Research Centre, Mater Health Services; the Queensland Centre for Evidence Based Nursing and Midwifery: a Collaborating Centre of the Joanna Briggs Institute.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

26447015

Citation

Cabilan, C J., et al. "The Effectiveness of Prehabilitation or Preoperative Exercise for Surgical Patients: a Systematic Review." JBI Database of Systematic Reviews and Implementation Reports, vol. 13, no. 1, 2015, pp. 146-87.
Cabilan CJ, Hines S, Munday J. The effectiveness of prehabilitation or preoperative exercise for surgical patients: a systematic review. JBI Database System Rev Implement Rep. 2015;13(1):146-87.
Cabilan, C. J., Hines, S., & Munday, J. (2015). The effectiveness of prehabilitation or preoperative exercise for surgical patients: a systematic review. JBI Database of Systematic Reviews and Implementation Reports, 13(1), pp. 146-87. doi:10.11124/jbisrir-2015-1885.
Cabilan CJ, Hines S, Munday J. The Effectiveness of Prehabilitation or Preoperative Exercise for Surgical Patients: a Systematic Review. JBI Database System Rev Implement Rep. 2015;13(1):146-87. PubMed PMID: 26447015.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effectiveness of prehabilitation or preoperative exercise for surgical patients: a systematic review. AU - Cabilan,C J, AU - Hines,Sonia, AU - Munday,Judy, PY - 2015/10/9/entrez PY - 2015/10/9/pubmed PY - 2015/10/9/medline SP - 146 EP - 87 JF - JBI database of systematic reviews and implementation reports JO - JBI Database System Rev Implement Rep VL - 13 IS - 1 N2 - BACKGROUND: Major surgery can induce functional decline and pain, which can also have negative implications on health care utilization and quality of life. Prehabilitation is the process of optimizing physical functionality preoperatively to enable the individual to maintain a normal level of function during and after surgery. Prehabilitation training can be a combination of aerobic exercises, strength training, and functional task training to suit individual needs. OBJECTIVES: To evaluate the impact of prehabilitation on physical functional status, health care utilization, quality of life, and pain after surgery. INCLUSION CRITERIA: Studies of adult surgical patients, excluding day surgery patients.Any preoperative exercise interventions identified in the study as part of a prehabilitation or preoperative exercise program, versus usual care.Randomized controlled trials.Functional status, health care utilization, quality of life and pain. SEARCH STRATEGY: Published (CINAHL, CENTRAL, EMBASE, MEDLINE, PEDro) and unpublished studies between 1996 and March 2013 were searched extensively. METHODOLOGICAL QUALITY: All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality. DATA COLLECTION: Data from included papers were extracted using a modified data extraction tool. DATA SYNTHESIS: Where possible, study results were pooled in statistical meta-analysis. Alternatively, results are presented in narrative and table form. RESULTS: A total of 3167 citations were identified; after removal of duplicates, assessment for relevance and eligibility, 33 studies underwent critical appraisal. Seventeen studies met the quality criteria and were included in quantitative synthesis. Thirteen studies were conducted in orthopedics (mainly knee or hip arthroplasty for osteoarthritis), one in colorectal, two in cardiac and one in upper gastrointestinal/hepatobiliary. Function, pain and quality of life were quantified according to prehabilitation dose and postoperative months. Prehabilitation, at any dose, did not demonstrate benefits in objective and self-reported function at any of the postoperative time points. Prehabilitation did not demonstrate benefits in quality of life or pain; however, there was significant evidence that prehabilitation doses of more than 500 minutes reduced the need for postoperative rehabilitation, but no significant reduction was found in readmissions or nursing home placement. CONCLUSIONS: Results from this review reveal that prehabilitation has no significant postoperative benefits in function, quality of life and pain in patients who have had knee or hip arthroplasty for osteoarthritis; however, there is evidence that prehabilitation may reduce admission to rehabilitation in this population. The evidence on postoperative benefits of prehabilitation in other surgical populations is limited; however, preliminary evidence does not demonstrate better outcomes. IMPLICATIONS FOR PRACTICE: There is no evidence that prehabilitation provides benefits in function, pain or quality of life in patients who have had arthroplasty for osteoarthritis; however prehabilitation doses of more than 500 minutes might reduce acute rehabilitation admissions. The evidence is insufficient to provide recommendations on the benefits of prehabilitation in other surgical populations. IMPLICATIONS FOR RESEARCH: Future prehabilitation studies are not recommended in patients with osteoarthritis for whom arthroplasty is planned. However, should prehabilitation be tested in other surgical populations, programs must consider patient suitability, setting, delivery of intervention and clinical effectiveness. It is also recommended that the exercises prescribed should be maintained and adhered to after surgery. Most importantly, prehabilitation studies must have adequately powered sample sizes. SN - 2202-4433 UR - https://www.unboundmedicine.com/medline/citation/26447015/The_effectiveness_of_prehabilitation_or_preoperative_exercise_for_surgical_patients:_a_systematic_review_ L2 - http://Insights.ovid.com/pubmed?pmid=26447015 DB - PRIME DP - Unbound Medicine ER -