Eubanks James E, Carlesso Cristiane, Sundaram Meenakshi, Bejarano Geronimo, Smeets Rob J E M, Skolasky Richard, Vanushkina Maria, Turner Rose, Schneider Michael J
Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA.
Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
PM R. 2023 Oct;15(10):1335-1350. doi: 10.1002/pmrj.12956. Epub 2023 Apr 3.
We aimed to identify and describe the current interventions used in preoperative programs ("prehabilitation") for spine surgery. Knowledge gaps in approaches, feasibility, timing, patient experience, clinical outcomes, and health care costs were explored while describing their potential benefits on physical and psychological outcomes. An electronic search was conducted from January 2004 to February 2022 in Ovid Medline, Embase, EBSCO CINAHL, the Cochrane Database of Systematic Reviews, and PEDro to identify studies in English evaluating adults enrolled in prehabilitation before undergoing elective spine surgeries. Studies were uploaded into DistillerSR for systematic screening after removing duplicates. Four reviewers screened nested references for inclusion based on titles and abstracts, followed by their full-text review. Two reviewers subsequently extracted data and summarized the results. The results were reported using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Studies were rated for quality using National Health and Medical Research Council criteria. Out of 18,879 potential studies, a total of 23 studies (0.12%) met the eligibility criteria and were included in this scoping review. The prehabilitation programs included general education (n = 6, 26%), exercise (n = 6, 26%), cognitive behavioral therapy (n = 3, 13%), pain neuroscience education (n = 3, 13%), health behavior counseling (n = 3, 13%), and mindfulness (n = 2, 9%). Additional studies are needed to identify optimal patient characteristics, intervention dosage, and whether multimodal approaches using a combination of physical and psychological strategies lead to more favorable outcomes. Although studies on prehabilitation for spine surgery are limited, they seem to demonstrate that prehabilitation programs are feasible, reduce medical expenditures, and improve patients' postoperative pain, disability, self-efficacy, psychological behaviors, and satisfaction with surgical outcomes. The available literature suggests there is an opportunity to improve patient experience, clinical outcomes and reduce medical costs with the use of prehabilitation in spine surgery.
我们旨在识别并描述目前脊柱手术术前计划（“术前康复”）中使用的干预措施。在描述这些干预措施对身体和心理结局的潜在益处时，我们探讨了其在方法、可行性、时机、患者体验、临床结局和医疗成本方面存在的知识空白。于2004年1月至2022年2月期间在Ovid Medline、Embase、EBSCO CINAHL、Cochrane系统评价数据库和PEDro中进行电子检索，以识别评估择期脊柱手术前接受术前康复的成年患者的英文研究。去除重复项后，将研究上传至DistillerSR进行系统筛选。四名评审员根据标题和摘要筛选纳入的嵌套参考文献，随后进行全文评审。两名评审员随后提取数据并总结结果。结果按照系统评价和Meta分析的首选报告项目扩展版的范围综述指南进行报告。使用澳大利亚国家卫生与医学研究委员会的标准对研究质量进行评分。在18879项潜在研究中，共有23项研究（0.12%）符合纳入标准并被纳入本范围综述。术前康复计划包括一般教育（n = 6，26%）、运动（n = 6，26%）、认知行为疗法（n = 3，13%）、疼痛神经科学教育（n = 3，13%）、健康行为咨询（n = 3，13%）和正念训练（n = 2，9%）。需要更多研究来确定最佳患者特征、干预剂量，以及采用身体和心理策略相结合的多模式方法是否能带来更有利的结局。尽管关于脊柱手术术前康复的研究有限，但这些研究似乎表明术前康复计划是可行的，可降低医疗支出，并改善患者术后疼痛、残疾、自我效能、心理行为以及对手术结局的满意度。现有文献表明，在脊柱手术中使用术前康复有机会改善患者体验、临床结局并降低医疗成本。
