Anthropology, Durham University, Durham, UK
Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK.
BMJ Open. 2021 Sep 7;11(9):e049202. doi: 10.1136/bmjopen-2021-049202.
To systematically review the impact of prehabilitation on objectively measured physical activity (PA) levels in elective surgery patients.
Articles published in Web of Science Core Collections, PubMed, Embase (Ovid), CINAHL (EBSCOHost), PsycInfo (EBSCOHost) and CENTRAL through August 2020.
Studies that met the following criteria: (1) written in English, (2) quantitatively described the effect(s) of a PA intervention among elective surgery patients prior to surgery and (3) used and reported objective measures of PA in the study.
Participant characteristics, intervention details, PA measurement, and clinical and health-related outcomes were extracted. Risk of bias was assessed following the revised Cochrane risk of bias tool. Meta-analysis was not possible due to heterogeneity, therefore narrative synthesis was used.
6533 unique articles were identified in the search; 21 articles (based on 15 trials) were included in the review. There was little evidence to suggest that prehabilitation is associated with increases in objectively measured PA, but this may be due to insufficient statistical power as most (n=8) trials included in the review were small feasibility/pilot studies. Where studies tested associations between objectively measured PA during the intervention period and health-related outcomes, significant beneficial associations were reported. Limitations in the evidence base precluded any assessment via meta-regression of the association between objectively measured PA and clinical or health-related outcomes.
Additional large-scale studies are needed, with clear and consistent reporting of objective measures including accelerometry variables and outcome variables, to improve our understanding of the impact of changes in PA prior to surgery on surgical and health-related outcomes.
CRD42019151475.
系统回顾术前康复对择期手术患者客观测量体力活动（PA）水平的影响。
通过 Web of Science 核心合集、PubMed、Embase（Ovid）、CINAHL（EBSCOHost）、PsycInfo（EBSCOHost）和 CENTRAL 检索，截至 2020 年 8 月发表的文章。
符合以下标准的研究：（1）用英语书写，（2）定量描述手术前择期手术患者 PA 干预的效果，（3）在研究中使用和报告 PA 的客观测量。
提取参与者特征、干预细节、PA 测量以及临床和健康相关结果。采用修订后的 Cochrane 偏倚风险工具评估偏倚风险。由于存在异质性，因此无法进行荟萃分析，故采用叙述性综合。
在搜索中确定了 6533 篇独特的文章；21 篇文章（基于 15 项试验）被纳入综述。几乎没有证据表明术前康复与客观测量的 PA 增加有关，但这可能是由于统计效力不足，因为纳入综述的大多数（n=8）试验都是小型可行性/试验研究。在那些测试干预期间客观测量的 PA 与健康相关结果之间的关联的研究中，报告了显著有益的关联。由于证据基础存在局限性，因此无法通过元回归来评估客观测量的 PA 与临床或健康相关结果之间的关联。
需要开展更多的大规模研究，明确一致地报告客观测量指标，包括加速度计变量和结果变量，以提高我们对术前 PA 变化对手术和健康相关结果的影响的理解。
PROSPERO 注册号：CRD42019151475。
