Effects of prehabilitation on outcomes following elective lumbar spine surgery: A systematic review and meta-analysis.

IF 1.3 Q4 CLINICAL NEUROLOGY
Lisandra Almeida de Oliveira, Julian Anthony Vitale, Jasmeet Singh Sachdeva, Srikesh Rudrapatna, Sava Ivosevic, Najih Nuradin Ismail, Anthony Cubello, Y V Raghava Neelapala, Nora Bakaa, Diego Roger-Silva, Luciana Macedo
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引用次数: 0

Abstract

Background: Elective lumbar spine surgery is increasingly being implemented to treat patients with specific low back pain. However, approximately 30% of patients continue to have long-term pain and disability after surgery.

Objective: The aim of this study was to systematically review the literature on the effectiveness of pre-surgical rehabilitation (prehab) alone or in combination with usual care versus usual care on patient-oriented outcomes and health-related costs following elective lumbar spine surgery.

Data sources: Electronic databases from MEDLINE, CINAHL, EMBASE, and AMED were systematically searched from their inception to November 2022.

Study selection: Randomized controlled trials that examined adult (age >18 years) prehab programs and evaluated one or more outcomes of interest were included in this review.

Data extraction: In pairs, six reviewers independently conducted a risk-of-bias assessment and extracted outcome data from included studies, in accordance with the Template for Intervention Description and Replication (TIDieR). A meta-analysis was conducted when trials were homogeneous.

Data synthesis: A total of eight trials (n = 739 participants), reported in 13 different manuscripts, were eligible for inclusion. Exercise prehab interventions are superior to usual care for disability at 3-month (MD: -2.56, 95% CI -4.98 to -0.15), back pain at 6-month (MD: -6.65, 95% CI -13.25 to -0.05), and health-related costs (MD: €2572.8, 95% CI: €1963.0 to €3182.5). CBT prehab interventions seem to be superior to usual care for back pain at 3-month (MD: -7.3, 95% CI: -14.5 to -0.05). Individual trials showed that education prehab interventions may be superior to usual for back pain at 1-month post-operative (MD: 12.3, 95% CI: 0.9 to 23.7).

Limitations: Overall, the inclusion of heterogeneous trials (e.g., diagnosis, types of surgery, dosage, content, and duration of interventions) with small sample sizes leads to inconclusive and very low certainty of effect estimates.

Conclusion: The present systematic review has brought to light the dearth of high-quality evidence in support of prehab interventions for patients undergoing lumbar spine surgery. Given the uncertainty surrounding the results obtained from low-quality randomized controlled trials, it is currently not feasible to provide recommendations for clinical practice.

择期腰椎手术后康复对预后的影响:一项系统回顾和荟萃分析。
背景:选择性腰椎手术越来越多地被用于治疗特殊腰痛患者。然而,大约30%的患者在手术后仍有长期疼痛和残疾。目的:本研究的目的是系统地回顾有关术前康复(prehab)单独或联合常规护理与常规护理在择期腰椎手术后以患者为导向的结果和健康相关费用方面的有效性的文献。数据来源:系统检索了MEDLINE、CINAHL、EMBASE和AMED的电子数据库,检索时间从建站到2022年11月。研究选择:本综述纳入了随机对照试验,这些试验检查了成人(年龄在0 - 18岁)的学前教育项目,并评估了一个或多个感兴趣的结果。数据提取:根据干预描述和复制模板(TIDieR), 6名评论者成对独立进行了偏倚风险评估,并从纳入的研究中提取了结果数据。当试验均质时进行荟萃分析。数据综合:共有8项试验(n = 739名受试者)报道于13份不同的手稿中,符合纳入条件。在3个月的残疾(MD: -2.56, 95% CI: -4.98至-0.15)、6个月的背痛(MD: -6.65, 95% CI: -13.25至-0.05)和健康相关费用(MD: 2572.8欧元,95% CI: 1963.0至3182.5欧元)方面,运动预防干预优于常规护理。CBT预干预似乎优于常规治疗3个月时的背痛(MD: -7.3, 95% CI: -14.5至-0.05)。个别试验表明,在术后1个月,教育干预可能优于常规的背部疼痛(MD: 12.3, 95% CI: 0.9至23.7)。局限性:总的来说,纳入小样本量的异质试验(如诊断、手术类型、剂量、内容和干预持续时间)导致效果估计的不确定性和非常低的确定性。结论:本系统综述显示,缺乏高质量的证据支持对腰椎手术患者进行预先干预。考虑到低质量随机对照试验结果的不确定性,目前为临床实践提供建议是不可行的。
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来源期刊
British Journal of Pain
British Journal of Pain CLINICAL NEUROLOGY-
CiteScore
3.20
自引率
11.10%
发文量
42
期刊介绍: British Journal of Pain is a peer-reviewed quarterly British journal with an international multidisciplinary Editorial Board. The journal publishes original research and reviews on all major aspects of pain and pain management. Reviews reflect the body of evidence of the topic and are suitable for a multidisciplinary readership. Where empirical evidence is lacking, the reviews reflect the generally held opinions of experts in the field. The Journal has broadened its scope and has become a forum for publishing primary research together with brief reports related to pain and pain interventions. Submissions from all over the world have been published and are welcome. Official journal of the British Pain Society.
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