术前运动对术后疼痛、功能、生活质量和并发症仅有轻微影响：系统评价和荟萃分析。

Preoperative Exercise Has a Modest Effect on Postoperative Pain, Function, Quality of Life, and Complications: A Systematic Review and Meta-Analysis.

机构信息

Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA.

出版信息

Phys Ther. 2023 Mar 3;103(3). doi: 10.1093/ptj/pzac169.

DOI:10.1093/ptj/pzac169

PMID:37172124

Abstract

OBJECTIVE

Preoperative exercise (prehabilitation) is commonly used as a method to reduce pain and improve function postoperatively. The purpose of this systematic review was to determine therapeutic benefits of preoperative exercise on postoperative pain, function, quality of life (QOL), and risk of complications across various types of surgeries.

METHODS

Three electronic databases were used to perform a literature search. Full articles with randomized designs comparing a preoperative exercise program vs no formal program were included. The primary outcome was postoperative pain. QOL, function, and postoperative complications were analyzed as secondary outcomes. The primary meta-analysis was performed in those with joint replacement surgery because there were only 5 with other surgical types.

RESULTS

A total of 28 articles were included, of which 23 were from individuals with total joint replacement surgery. Preoperative exercise resulted in lower pain ≤2 months and 3 to 5 months after joint replacement surgery with a moderate standardized mean difference (95% CI at <2 months = -0.34 [-0.59 to -0.09]; at 3 to 5 months = -0.41 [-0.70 to -0.11]) compared with nonexercised controls. However, ≥6 months after joint replacement surgery, preoperative exercise groups showed no significant differences in postoperative pain (standardized mean difference = -0.17 [-0.35 to 0.01]) compared with nonexercised controls. QOL and subjective and objective function were improved ≤2 months after joint replacement surgery but were not different ≥6 months post-surgery. Reduction in risk of postoperative complications was favored with preoperative exercise.

CONCLUSION

Preoperative exercise has a modest effect on postoperative pain, function, and quality of life within the first 6 months after surgery and reduces the risk of developing postoperative complications in individuals undergoing joint replacement surgery. The effect of preoperative exercise on other surgery types is inconclusive.

IMPACT

This systematic review supports using preoperative exercise to improve pain and function outcomes for those with joint replacement surgery.

摘要

目的

术前运动（康复）通常被用作减轻术后疼痛和改善功能的方法。本系统评价的目的是确定各种类型手术中术前运动对术后疼痛、功能、生活质量（QOL）和并发症风险的治疗益处。

方法

使用三个电子数据库进行文献检索。纳入了比较术前运动计划与非正规计划的随机设计的全文文章。术后疼痛是主要结局。分析了 QOL、功能和术后并发症作为次要结局。由于只有 5 项研究涉及其他手术类型，因此主要的荟萃分析是在接受关节置换手术的患者中进行的。

结果

共纳入 28 篇文章，其中 23 篇来自接受全关节置换手术的患者。与未进行锻炼的对照组相比，术前运动可使关节置换术后≤2 个月和 3 至 5 个月时的疼痛降低（<2 个月时的标准化均数差（95%CI）为-0.34[-0.59 至-0.09]；3 至 5 个月时为-0.41[-0.70 至-0.11]）。然而，关节置换术后≥6 个月时，与未进行锻炼的对照组相比，术前运动组的术后疼痛无显著差异（标准化均数差=-0.17[-0.35 至 0.01]）。关节置换术后≤2 个月时，QOL 和主观及客观功能得到改善，但≥6 个月时则无差异。术前运动可降低术后并发症的风险。