Fernández-Costa Damián, Gómez-Salgado Juan, Castillejo Del Río Andrés, Borrallo-Riego Álvaro, Guerra-Martín María Dolores
Primary Care Urgency Service, Huelva-Costa Device, 21003 Huelva, Spain.
Sociology, Social Work and Public Health Department, University of Huelva, 21007 Huelva, Spain.
Healthcare (Basel). 2021 Nov 22;9(11):1602. doi: 10.3390/healthcare9111602.
an increasing number of advanced age patients are considered for cardiothoracic surgeries. Prehabilitation optimizes the patients' functional capacity and physiological reserve. However, the effectiveness of prehabilitation on physical functioning and postoperative recovery in the scope of cardiothoracic surgery is still uncertain.
to assess the effectiveness of prehabilitation on pre- and/or postoperative functional capacity and physiological reserve in aged patients that are considered for cardiothoracic surgeries.
this systematic review was registered in PROSPERO (CRD42021247117). The searches were conducted in PubMed, Web of Science, Scopus, and Cochrane CENTRAL until 18 April 2021. Randomized clinical trials that compared different prehabilitation strategies with usual care on the pre- and-postoperative results in aged patients undergoing cardiothoracic surgeries were included. Methodological quality was assessed by means of the Jadad scale, and the effectiveness of the interventions according to the Consensus on Therapeutic Exercise Training.
nine studies with 876 participants aged from 64 to 71.5 years old were included. Risk of bias was moderate due to the absence of double-blinding. The content of the interventions (multimodal prehabilitation n = 3; based on physical exercises n = 6) and the result measures presented wide variation, which hindered comparison across the studies. In general, the trials with better therapeutic quality (n = 6) reported more significant improvements in physical functioning, cardiorespiratory capacity, and in the postoperative results in the participants under-going prehabilitation.
prehabilitation seems to improve functional capacity and postoperative recovery in aged patients undergoing cardiothoracic surgeries. However, due to the significant heterogeneity and questionable quality of the trials, both the effectiveness of prehabilitation and the optimum content are still to be determined.
越来越多的高龄患者被考虑进行心胸外科手术。术前康复可优化患者的功能能力和生理储备。然而，在心胸外科手术范围内，术前康复对身体功能和术后恢复的有效性仍不确定。
评估术前康复对考虑进行心胸外科手术的老年患者术前和/或术后功能能力及生理储备的有效性。
本系统评价在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42021247117）进行了注册。检索了截至2021年4月18日的PubMed、科学网、Scopus和Cochrane中心对照试验注册库。纳入了比较不同术前康复策略与常规护理对接受心胸外科手术老年患者术前和术后结果影响的随机临床试验。采用雅达量表评估方法学质量，并根据治疗性运动训练共识评估干预措施的有效性。
纳入了9项研究，共876名年龄在64至71.5岁之间的参与者。由于缺乏双盲法，偏倚风险为中度。干预措施的内容（多模式术前康复n = 3；基于体育锻炼n = 6）和结果测量差异很大，这妨碍了各研究之间的比较。总体而言，治疗质量较好的试验（n = 6）报告称，接受术前康复的参与者在身体功能、心肺功能和术后结果方面有更显著的改善。
术前康复似乎可改善接受心胸外科手术老年患者的功能能力和术后恢复。然而，由于试验存在显著异质性和质量存疑，术前康复的有效性和最佳内容仍有待确定。
