Hijmans Juha M, Dekker Rienk, Geertzen Jan H B
University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, PO Box 30.001, 9700RB Groningen, the Netherlands.
University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, PO Box 30.001, 9700RB Groningen, the Netherlands.
Med Hypotheses. 2020 Oct;143:110134. doi: 10.1016/j.mehy.2020.110134. Epub 2020 Jul 26.
Major lower-limb amputation (LLA) is a life-changing event associated with poor post-operative physical and psychological functioning and decreased quality of life. The general physical condition of most LLA patients prior to surgery is already significantly deteriorated due to chronic peripheral vascular disease often in combination with diabetes. Pre-operative rehabilitation (also called 'pre-rehabilitation') is an increasingly common strategy used in multiple patient populations to improve patients' physical and mental condition prior to surgery, thus aiming at improving the post-operative patient outcomes. Given the positive effects of post-surgical outcomes in many patient populations, we hypothesize that pre-operative rehabilitation will improve post-operative outcomes after LLA. To test this hypothesis, a literature search of PubMed, EMBASE, EBSCOhost, Web of Science and ScienceDirect was performed to identify studies that investigated the impact of a pre-operative rehabilitation therapy on post-operative outcomes such as length of hospital stay, mobility, physical functioning, and health related quality of life. No time restrictions were applied to the search. Only articles published in English were included in the selection. Two studies satisfied the eligibility criteria for inclusion in the review, one qualitative and one quantitative study. The quantitative study reported a beneficial effect of pre-rehabilitation, resulting in post-operative mobility (at least indoor ambulation) in 63% of the included LLA patients. There is a need for prospective clinical studies examining the effect of pre-rehabilitation on post-operative outcomes to be able to confirm or reject our hypothesis. Although the hypothesis seems plausible, evidence is lacking to support our hypothesis that pre-operative rehabilitation will improve post-operative outcomes in patients with LLA. The qualitative study indicated that integrating pre-rehabilitation in the care for LLA patients seems to be limited to a selected group of dysvascular patients, but at this stage cannot be advised based on current evidence even in this subgroup. Further research is needed to clarify whether such an intervention prior to amputation would be a useful and effective tool for optimizing post-operative outcomes in LLA patients.
大下肢截肢（LLA）是一个改变生活的事件，与术后身体和心理功能不佳以及生活质量下降相关。由于慢性外周血管疾病常合并糖尿病，大多数LLA患者术前的一般身体状况已显著恶化。术前康复（也称为“预康复”）是一种在多个患者群体中越来越常用的策略，用于改善患者术前的身心状况，从而旨在改善术后患者的预后。鉴于在许多患者群体中术后结果有积极影响，我们假设术前康复将改善LLA术后的结果。为了验证这一假设，我们对PubMed、EMBASE、EBSCOhost、Web of Science和ScienceDirect进行了文献检索，以确定研究术前康复治疗对术后结果（如住院时间、活动能力、身体功能和健康相关生活质量）影响的研究。检索没有时间限制。入选的仅为英文发表的文章。两项研究符合纳入综述的资格标准，一项定性研究和一项定量研究。定量研究报告了预康复的有益效果，63%纳入的LLA患者术后能够活动（至少在室内行走）。需要进行前瞻性临床研究来检验预康复对术后结果的影响，以便能够证实或反驳我们的假设。尽管这个假设似乎合理，但缺乏证据支持我们的假设，即术前康复将改善LLA患者的术后结果。定性研究表明，将预康复纳入LLA患者的护理似乎仅限于一组特定的血管性疾病患者，但即使在这个亚组中，目前也不能根据现有证据给出建议。需要进一步研究来阐明截肢前的这种干预是否会成为优化LLA患者术后结果的有用且有效的工具。
