Journal of Orthopaedic & Sports Physical Therapy
Published Online: February 28, 2021Volume 51 Issue 3 Pages103-114
https://www.jospt.org/doi/10.2519/jospt.2021.9748

Abstract
Objective
To assess the effectiveness of prehabilitation in patients with degenerative disorders of the lumbar spine who are scheduled for spine surgery.

Design
Intervention systematic review with meta-analysis.

Literature Search
Seven electronic databases were systematically searched for randomized controlled trials or propensity-matched cohorts.

Study Selection Criteria
Studies that measured the effect of prehabilitation interventions (ie, exercise therapy and cognitive behavioral therapy [CBT]) on physical functioning, pain, complications, adverse events related to prehabilitation, health-related quality of life, psychological outcomes, length of hospital stay, use of analgesics, and return to work were included.

Data Synthesis
Data were extracted at baseline (preoperatively) and at short-term (6 weeks or less), medium-term (greater than 6 weeks and up to 6 months), and long-term (greater than 6 months) follow-ups. Pooled effects were analyzed as mean differences and 95% confidence intervals (CIs). Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Results
Cognitive behavioral therapy interventions were no more effective than usual care for all outcomes. Pooled effect sizes were −2.0 (95% CI: −4.4, 0.4) for physical functioning, −1.9 (95% CI: −5.2, 1.4) for back pain, and −0.4 (95% CI: −4.1, 0.4) for leg pain. Certainty of evidence for CBT ranged from very low to low. Only 1 study focused on exercise therapy and found a positive effect on short-term outcomes.

Conclusion
There was very low–certainty to low-certainty evidence of no additional effect of CBT interventions on outcomes in patients scheduled for lumbar surgery. Existing evidence was too limited to draw conclusions about the effects of exercise therapy. J Orthop Sports Phys Ther 2021;51(3):103–114. Epub 25 Dec 2020. doi:10.2519/jospt.2021.9748

Journal Reference