Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK.
Oxford Allied Health Professions Research and innovations Unit (AHPRU), Oxford University Hospitals NHS Foundation Trust, UK.
Disabil Rehabil. 2024 Dec;46(24):5676-5699. doi: 10.1080/09638288.2024.2310765. Epub 2024 Feb 7.
This review synthesised the evidence for the effect of prehabilitation interventions on biopsychosocial and service outcomes.
A systematic review was conducted. 10 databases were searched to December 2023. Prospective experimental studies exploring prehabilitation interventions in adults undergoing upper gastrointestinal surgery were included. Prehabilitation was any preoperative intervention to improve physical or psychological outcomes. Included studies required a comparator group or alternative preoperative intervention as well as baseline, presurgical and postoperative assessment points. Study quality was assessed using the Cochrane risk of bias tool (v.2). Data synthesis was narrative (SWiM guidance).
6028 studies were screened, with 25 studies included. Prehabilitation interventions were: inspiratory muscle training (five studies = 450); exercise (nine studies = 683); psychological (one study = 400); and nutritional (ten studies = 487). High quality studies showed preoperative improvements in impairments directly targeted by the interventions. Generally, these did not translate into functional or postoperative improvements, but multimodal interventions were more promising.
Current evidence supports prehabilitation as safe to preserve or improve preoperative function. Heterogeneity in outcomes and variable study quality means definitive conclusions regarding interventions are not yet possible, limiting implementation. Agreement of clinical outcomes and cost effectiveness evaluation is required.
本综述综合了术前康复干预对生物心理社会和服务结果影响的证据。
进行了系统综述。检索了 10 个数据库，截至 2023 年 12 月。纳入了探索上消化道手术成人术前康复干预的前瞻性实验研究。术前康复是指任何旨在改善身体或心理结果的术前干预。纳入的研究需要有对照组或替代术前干预以及基线、术前和术后评估点。使用 Cochrane 偏倚风险工具（v.2）评估研究质量。数据综合采用叙述性方法（SWiM 指南）。
筛选出 6028 篇研究，纳入 25 项研究。术前康复干预措施包括：吸气肌训练（5 项研究=450）；运动（9 项研究=683）；心理（1 项研究=400）；营养（10 项研究=487）。高质量研究显示术前干预直接针对的功能障碍得到改善。一般来说，这些改善并没有转化为功能或术后的改善，但多模式干预更有希望。
目前的证据支持术前康复是安全的，可以保持或改善术前功能。由于结局的异质性和研究质量的变化，目前还不可能对干预措施得出明确的结论，限制了其实施。需要达成临床结局和成本效益评估的一致意见。
