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Effect of preparative rehabilitation on recovery after cardiac surgery: a systematic review - 21/05/20

Doi : 10.1016/j.rehab.2020.03.014 
Derek King Wai Yau, BScPT MScMed a , Malcolm John Underwood, MB ChB MD FRCS b , Gavin Matthew Joynt, MB BCh FCICM a , Anna Lee, MPH PhD a,
a Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China 
b Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, 7/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China 

Address for correspondence: Office 21, Department of Anaesthesia and Intensive Care, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, ChinaOffice 21, Department of Anaesthesia and Intensive Care4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, ShatinNew TerritoriesHong Kong SARChina
Sous presse. Manuscrit accepté. Disponible en ligne depuis le jeudi 21 mai 2020

Abstract

Background. Physical prehabilitation (preparative rehabilitation) programs may have beneficial effects on enhancing physical strength and functional status before surgery, but their effects on postoperative recovery are unclear.

Objectives. This systematic review investigated the effectiveness of physical prehabilitation programs before cardiac surgery on postoperative recovery and other perioperative outcomes.

Methods. We searched for reports of randomised controlled trials of any prehabilitation programs that included physical activity or an exercise training component in adults undergoing elective cardiac surgery, published in any language, from six bibliographic databases (last search on June 20, 2019). We assessed trials for risk of bias, overall certainty of evidence and quality of intervention reporting using the Cochrane Risk of Bias Assessment Tool, GRADE system and the Template for Intervention Description and Replication checklist and guide, respectively.

Results. All 7 studies (726 participants) were at high risk of bias because of lack of blinding. The quality of prehabilitation reporting was moderate because program adherence was rarely assessed. The timing of prehabilitation ranged from 5 days to 16 weeks before surgery and from face-to-face exercise prescription to telephone counselling and monitoring. We found uncertain effects of prehabilitation on postoperative clinical outcomes (among the many outcomes assessed): perioperative mortality (Peto odds ratio 1.30, 95% confidence interval [CI] 0.28 to 5.95; I2=0%; low-certainty evidence) and postoperative atrial fibrillation (relative risk 0.75, 95% CI 0.38 to 1.46; I2=50%; very low-certainty evidence). However, prehabilitation may improve postoperative functional capacity and slightly shorten the hospital stay (mean difference -0.66 days, 95% CI -1.29 to -0.03; I2=45%; low-certainty evidence).

Conclusion. Despite the high heterogeneity among physical prehabilitation trials and the uncertainty regarding robust clinical outcomes, physical prehabilitation before cardiac surgery seems to enhance selected postoperative functional performance measures and slightly reduce the hospital length of stay after cardiac surgery.

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Keywords : exercise therapy, rehabilitation, preoperative care, postoperative complications



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