Does preoperative physical therapy/prehabilitation affect outcome or complications after surgery for lumbar disc herniation? A systematic review.

Introduction: Preoperative physical and psychological conditioning or 'prehabilitation', has emerged as a potential strategy to enhance surgical outcomes. While recent studies have investigated the role prehabilitation in spinal surgery, its specific role in lumbar disc herniation remains insufficiently defined.

Objective: To evaluate the impact of preoperative physical therapy/rehabilitation on postoperative outcomes and complications in patients undergoing surgery for lumbar disc herniation, compared to standard preoperative care. before surgery for lumbar disc herniation in the global outcome compared with the preoperative usual care in waiting list.

Methods: This systematic review searched 4 databases from January 2000 to March 2023. All studies (randomized clinical trials and observational studies) assessing the effects of prehabilitation in adult patients undergoing lumbar spine surgery, were eligible for inclusion. Five studies (n = 736) met inclusion criteria.

Results: All included studies reported short-term improvements in pain, functional outcomes, and psychological readiness following prehabilitation. However, these benefits were not sustained at 6- or 12-months follow-up in most studies. Outcomes converged between intervention and control groups over time. One study highlighted that higher-intensity, supervised programs yielded greater early benefits than unsupervised protocols.

Conclusion: Prehabilitation appears to be a promising intervention for enhancing short-term recovery following lumbar spine surgery. Nevertheless, its long-term effectiveness remains uncertain. The current evidence is limited by clinical heterogeneity and lack of lumbar disc herniation specific trials. Future long-term, standardized, high-quality studies are essential to define its role in surgical outcomes.