Department of Life Sciences, Manchester Metropolitan University, John Dalton Building; Chester Street, Manchester M1 5GD, United Kingdom; Department of Anaesthesia, Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK; Manchester Metropolitan University, Institute of Sport, Manchester, United Kingdom; Musculoskeletal Science and Sports Medicine, Manchester Metropolitan University, Manchester, United Kingdom.
Manchester Metropolitan University, Institute of Sport, Manchester, United Kingdom; Musculoskeletal Science and Sports Medicine, Manchester Metropolitan University, Manchester, United Kingdom.
J Clin Anesth. 2023 Jun;86:111053. doi: 10.1016/j.jclinane.2023.111053. Epub 2023 Feb 1.
The optimal package of components for a prehabilitation intervention remains unclear. The aim was to determine the efficacy of supervised exercise prehabilitation programs to enhance patient fitness and improve surgical outcomes. The protocol was preregistered (PROSPERO: CRD42020180693). PubMed, MEDLINE, CINAHL, AMED, CENTRAL, PeDro, ClinicalTrials.gov and the WHO International Clinical Trials Registry were searched. Randomized controlled trials (RCTs) of supervised prehabilitation programs before major abdominal surgery were included. Physical function, cardiorespiratory capacity and surgical outcomes were the primary outcomes measures. Risk of bias was assessed according to the Cochrane Risk of Bias 1.0 tool for RCTs. Data are summarized narratively, and where possible, quantitavely. Meta-analyses results are reported as risk ratios (RR), mean difference of changes between baseline and follow-up time points or mean difference between groups and 95% confidence interval (CI). Twenty RCTs were included in the analysis with a total of 1258 patients. The average 6-min walking distance change was +33 m in the prehabilitation group compared to the usual care (UC) group after prehabilitation (95% CI: [13, 53], P < 0.01). Only in studies with more than one supervised session per week changes in 6-min-walk distance were significantly higher in the prehabilitation group compared to the UC group after prehabiliatation (Mean difference: 47 m, 95% [CI]: [20-75], P < 0.01). The change in peak volume of oxygen uptake during a maximum cardiopulmonary test was +1.47 mL·kg·min in the prehabilitation group compared to the UC group (95% CI: [0.68, 2.25], P < 0.01). There was no significant difference in the change in oxygen uptake at anaerobic threshold between groups (Mean differences: 0.47, 95% CI: [-0.16, 1.10], P:0.14). Post-operative complications incidence was similar between groups (RR: 0.80, 95% CI: [0.61, 1.05], P:0.11), irrespective of the frequency of supervised session per week (RR: 0.67, 95% CI: [0.43, 1.03], P:0.07). In conclusion, prehabilitation programmes with more than one supervised session per week improved physical function but did not enhance surgical outcomes.
术前强化干预的最佳组件方案仍不明确。本研究旨在确定监督下的运动术前强化方案对增强患者体能和改善手术结果的疗效。方案已预先注册（PROSPERO：CRD42020180693）。检索了 PubMed、MEDLINE、CINAHL、AMED、CENTRAL、PeDro、ClinicalTrials.gov 和世界卫生组织国际临床试验注册平台。纳入了主要腹部手术后监督下术前强化方案的随机对照试验（RCT）。主要结局测量指标为身体功能、心肺能力和手术结果。根据 Cochrane 偏倚风险工具 1.0 对 RCT 进行了偏倚风险评估。根据需要，以叙述性方式汇总数据，并进行定量分析。报告了荟萃分析结果为风险比（RR）、基线和随访时间点之间变化的平均值差异或组间差异和 95%置信区间（CI）。共有 20 项 RCT 纳入分析，共 1258 例患者。与常规护理（UC）组相比，术前强化组的 6 分钟步行距离平均变化增加了+33m（95%CI：[13，53]，P<0.01）。仅在每周监督治疗次数多于一次的研究中，术前强化组的 6 分钟步行距离变化明显高于 UC 组（平均差异：47m，95%CI：[20，75]，P<0.01）。在最大心肺测试期间，峰值摄氧量的变化，与 UC 组相比，术前强化组增加了+1.47mL·kg·min（95%CI：[0.68，2.25]，P<0.01）。两组间无氧阈时摄氧量的变化无显著差异（平均差异：0.47，95%CI：[-0.16，1.10]，P：0.14）。两组术后并发症发生率相似（RR：0.80，95%CI：[0.61，1.05]，P：0.11），无论每周监督治疗次数如何（RR：0.67，95%CI：[0.43，1.03]，P：0.07）。总之，每周监督治疗次数多于一次的术前强化方案可改善身体功能，但不能提高手术结果。
