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-analyses.

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 (i.e., 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), short-term (≤ 6 weeks), mid-term (>6 weeks and ≤6 months) and long-term (>6 months). Pooled effects were analyzed as mean differences and 95% confidence intervals (CI). Certainty of evidence was assessed using the Grading of Recommendations Assessment Development and Evaluations (GRADE) framework.

Results:

CBT 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 one intervention focused on exercise therapy and found a positive effect on short term outcomes.

Conclusion:

There was very low to low certainty evidence of no additional effect of CBT interventions on outcomes of patients scheduled for lumbar surgery. Existing evidence was too limited to draw conclusions about the effects of exercise therapy. J Orthop Sports Phys Ther, Epub 25 Dec 2020. doi:10.2519/jospt.2021.9748.