居家预康复：随机试验的系统评价与荟萃分析
Home-based prehabilitation: a systematic review and meta-analysis of randomised trials.
作者信息
D'Amico Filippo, Dormio Sara, Veronesi Giulia, Guarracino Fabio, Donadello Katia, Cinnella Gilda, Rosati Riccardo, Pecorelli Nicolò, Baldini Gabriele, Pieri Marina, Landoni Giovanni, Turi Stefano
机构信息
Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
出版信息
Br J Anaesth. 2025 Apr;134(4):1018-1028. doi: 10.1016/j.bja.2025.01.010. Epub 2025 Feb 6.
BACKGROUND
Prehabilitation aims to enhance preoperative functional capacity through exercise, nutrition, and psychological programs. Home-based prehabilitation represents an alternative to hospital prehabilitation, with the advantage of not utilising hospital resources. This review aims to evaluate adherence and clinical effectiveness of home-based prehabilitation.
METHODS
We searched PubMed, Cochrane, and Embase up to October 1, 2024 for randomised controlled trials comparing home-based prehabilitation with standard care. The primary outcome was the proportion of patients with postoperative complications. Secondary outcomes included protocol adherence, and 6-min walking test. We used risk ratios (RR) and mean differences to summarise the results. The risk of bias was assessed using RoB 2 tool.
RESULTS
We included 29 randomised trials for a total of 3508 patients. Median adherence to home-based prehabilitation programs was 82%. Home-based prehabilitation reduced the proportion of patients with postoperative complications (508/1322 [38.4%] vs 578/1335 [43.3%], risk ratio 0.84, 95% confidence interval [CI] 0.72-0.98, P=0.02, I=44%, low certainty). After home-based prehabilitation, 6-min walking test performance was better compared with control (MD 28.2 m (95% CI 9.5-46.9; P<0.01, I=48). Preoperative depression (MD -0.65, 95% CI -0.87 to -0.43; P<0.001, I=0%), postoperative anxiety (MD -0.50, 95% CI -0.75 to -0.25; P<0.001, I=0%, low certainty) and length of hospital stays (MD -0.32 days, 95% CI -0.61 to -0.03; P=0.03, I=45%, low certainty) were lower with home-based prehabilitation.
CONCLUSIONS
Home-based prehabilitation reduced the proportion of patients with postoperative complications, but with low certainty of evidence. It also improved preoperative functional capacity, reduced hospital stays, depression and anxiety scores, with good adherence to the intervention.
SYSTEMATIC REVIEW PROTOCOL
PROSPERO (CRD42024591208).
背景
术前康复旨在通过运动、营养和心理项目提高术前功能能力。居家术前康复是医院术前康复的一种替代方式，具有不占用医院资源的优势。本综述旨在评估居家术前康复的依从性和临床效果。
方法
我们检索了截至2024年10月1日的PubMed、Cochrane和Embase数据库，以查找比较居家术前康复与标准护理的随机对照试验。主要结局是术后并发症患者的比例。次要结局包括方案依从性和6分钟步行试验。我们使用风险比（RR）和均值差来汇总结果。使用RoB 2工具评估偏倚风险。
结果
我们纳入了29项随机试验，共3508例患者。居家术前康复项目的中位依从率为82%。居家术前康复降低了术后并发症患者的比例（508/1322 [38.4%] 对比578/1335 [43.3%]，风险比0.84，95%置信区间 [CI] 0.72 - 0.98，P = 0.02，I² = 44%，低确定性）。居家术前康复后，6分钟步行试验表现优于对照组（均值差28.2 m（95% CI 9.5 - 46.9；P < 0.01，I² = 48）。术前抑郁（均值差 -0.65，95% CI -0.87至 -0.43；P < 0.001，I² = 0%）、术后焦虑（均值差 -0.50，95% CI -0.75至 -0.25；P < 0.001，I² = 0%，低确定性）和住院时间（均值差 -0.32天，95% CI -0.61至 -0.03；P = 0.03，I² = 45%，低确定性）在居家术前康复组更低。
结论
居家术前康复降低了术后并发症患者的比例，但证据确定性较低。它还改善了术前功能能力，缩短了住院时间，降低了抑郁和焦虑评分，且对干预的依从性良好。
系统评价方案
PROSPERO（CRD42024591208）。
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