10/09/2015

Effectoftotalbodyprehabilitationonpostoperativeoutcomes:asystematicreviewandmetaanalysisPubMedHealth

PubMedHealth.AserviceoftheNationalLibraryofMedicine,NationalInstitutesofHealth.

DatabaseofAbstractsofReviewsofEffects(DARE):QualityassessedReviews[Internet].York(UK):CentreforReviewsand
Dissemination(UK)1995.

Effectoftotalbodyprehabilitationonpostoperativeoutcomes:asystematic
reviewandmetaanalysis
DSantaMina,HClarke,PRitvo,YWLeung,AGMatthew,JKatz,JTrachtenberg,andSMAlibhai.
Reviewpublished:2014.

CRDsummary
Thisreviewconcludedthatpreoperativewholebodyexerciseprogrammes(prehabilitation)couldshortenhospitalstayand
providepostoperativephysicalbenefits,butstudyqualitywaslimitedandtherewassignificantriskofbiasintheincludedstudies.
Thisconclusionwasappropriatelylimited,andislikelytobereliable.

Authors'objectives
Toassesstheeffectsofpreoperativeexercise(prehabilitation)onperioperativeandpostoperativeoutcomes,foradultsundergoing
surgery.

Searching
Sixdatabases,includingMEDLINEandPEDro,weresearchedforarticlesfrom1950toAugust2011.Searchtermswerereported
inanonlineappendix.Referencesofrelevantstudieswerechecked,andauthorswerecontacted,toidentifyadditionalstudies.

Studyselection
Prospectivetrialsthatassessedrehabilitationbeforesurgery,whichcomprisedwholebodyexercise,forpatientsagedatleast18
years,wereeligibleforinclusion.Therewerenorestrictionsontheduration,typeorintensityoftheexercise,buttheprogrammes
hadtospecifythesecriteria.
Twothirdsoftheincludedtrialsassessedorthopaedicpatients,andtheremainderassessedpatientsundergoingvisceralsurgery.
Exercisewasundertakenatafacility,athome,orboth.Mosttrialsassessedbothaerobicandresistanceorcalisthenicexercise.
Themediantrialdurationwassixweeks(rangeonetoeight).Severaltrialsincorporatedelementssuchasdietarychangesor
patienteducation.
Tworeviewersindependentlyassessedthestudiesforinclusiondiscrepancieswereresolvedbyathirdreviewer.

Assessmentofstudyquality
TworeviewersindependentlyassessedthetrialsusingtheCochraneriskofbiastool,adaptedtoawarduptoatotalof6points
disagreementswereresolvedbyathirdreviewer.

Dataextraction
Tworeviewersindependentlyextractedtheoutcomedata,onanintentiontotreatbasis.Effectsizes(Hedges'g)werecalculated
forcontinuousoutcomes.Athirdreviewerresolveddisagreementsauthorswerecontactedtoverifythedata.

Methodsofsynthesis
Theeffectsizeswerepooledinametaanalysis,weightedbyinversevariance,providedthattheoutcomewasreportedconsistently
byatleastthreetrials.HeterogeneitywasevaluatedusingCochran'sQand.Publicationbiaswasassessedinafunnelplotand
usingBegg'sandEgger'stests.

Resultsofthereview
Twentyonestudies,with1,371patients,wereincludedinthereview.Seventeenwererandomisedcontrolledtrials(RCTs),one
wasanonrandomisedcontrolledtrial,andtheotherswerecasecontrol,uncontrolledorcasestudies.Samplesizesrangedfrom
twoto246.Theriskofbiaswassignificantonestudyhadalowriskofbiasonallcriteria(score6),andfourscored4ormore.
Allocationconcealmentwasadequateinsixstudies,andincompleteoutcomedatawereaddressedadequatelyinthreestudies.
Thepooledeffectsizeforlengthofhospitalstaywas0.39days(95%CI0.76to0.029)basedonninestudies.Heterogeneitywas
high(=82.85%).Therewasasuggestionofpublicationbiasinthefunnelplot.
Theoutcomesforpreoperativephysicalfunction,postoperativequalityoflife,pain,functionaltaskperformance,fitness,
satisfaction,andhealthcareusewerereportedinanarrative,withmixedresults.Fulldetailsweregiven.

Authors'conclusions
Prehabilitationcouldshortenhospitalstayandprovidepostoperativephysicalbenefits,butstudyqualitywaslimitedandthere
wassignificantriskofbiasintheincludedstudies.

CRDcommentary
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0062626/?report=printable

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10/09/2015

Effectoftotalbodyprehabilitationonpostoperativeoutcomes:asystematicreviewandmetaanalysisPubMedHealth

Thereviewaddressedaclearquestion,supportedbyreasonableinclusioncriteria,exceptthattheoutcomeswerenotspecified.The
searchwasreasonablyextensive,withnolimitations.Theauthorsusedmethodstoreducereviewerbiasanderrorthroughoutthe
review.Thequalityassessmentwasreasonable,butthetoolwasdesignedforRCTsandnotintendedtobeusedtogeneratea
summaryscore.Therewassomeindicationofpublicationbiasinthefunnelplot,buttheutilityofsuchplotsforfewerthan10
studiesislimited.Thesynthesiswasappropriate.
Theconclusionsarereasonableandtakeaccountofthehighrisksofbiasintheincludedstudies.

Implicationsofthereviewforpracticeandresearch
Practice:Theauthorsdidnotstateanyimplicationsforpractice.
Research:TheauthorsstatedthatadequatelypoweredRCTs,withconsistentandclinicallyrelevantoutcomemeasures
(suggestionsinthepaper),wereneeded.

Funding
Nospecificfundingreceived.

Bibliographicdetails
SantaMinaD,ClarkeH,RitvoP,LeungYW,MatthewAG,KatzJ,TrachtenbergJ,AlibhaiSM.Effectoftotalbody
prehabilitationonpostoperativeoutcomes:asystematicreviewandmetaanalysis.Physiotherapy2014100(3):196207.
[PubMed:24439570]

IndexingStatus
SubjectindexingassignedbyCRD

MeSH
PostoperativeComplicationsPreoperativeCareHumansExerciseTherapy

AccessionNumber
12014008083

Databaseentrydate
15/05/2014

RecordStatus
ThisisacriticalabstractofasystematicreviewthatmeetsthecriteriaforinclusiononDARE.Eachcriticalabstractcontainsa
briefsummaryofthereviewmethods,resultsandconclusionsfollowedbyadetailedcriticalassessmentonthereliabilityofthe
reviewandtheconclusionsdrawn.

CRDhasdeterminedthatthisarticlemeetstheDAREscientificqualitycriteriaforasystematicreview.
Copyright2014UniversityofYork.
PMID:24439570

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0062626/?report=printable

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