JMIR Publications

ABSTRACT

Background:

Prehabilitation delivered with advanced technologies represent a great chance for patients to optimize pre and postoperative outcomes, reduce costs and overcome travelling barriers.

Objective:

To evaluate the effects of prehabilitation delivered with advanced technologies in patients affected by musculoskeletal diseases and waiting for surgery on clinical relevant outcomes.

Methods:

We searched PubMed, EMBASE, Cochrane Library, PEDro and Cinhal databases up to February 2nd 2023.ClinicalTrials.gov was also searched for registered protocols. Randomized Controlled Trials and Non-Randomized Intervention Studies with adult participants of both sexes, affected by any musculoskeletal disease, undergoing prehabilitation with advanced technologies or standard care. Study selection, data extraction and critical appraisal were conducted in duplicate. Data were pooled for meta-analysis using random-effects models. Certainty of evidence was assessed for the primary outcome with the Grading of Recommendations Assessment, Development and Evaluation system. The primary outcome was function. Secondary outcomes were pain, strength, risk of fall, autonomy in the activities of daily living, patient’s satisfaction, health related quality of life, adverse events and adherence to treatment.

Results:

Seven studies, focusing on patients undergoing total knee or hip arthroplasty, primary meniscal tear and spine surgery, were included. We found different prehabilitation programs: mindfulness-based stress reduction, exercise, education or a combination thereof. Prehabilitation delivered with advanced technologies proved to be more effective in improving function in candidates to knee or hip replacement (Western Ontario McMaster Osteoarthritis Index ‘function subscale’ before surgery: MD, -7.45; CI 95%, from -10.71 to -4.19, I2= 0%; after surgery: MD -7.84; 95% CI -11.80; -3.88, I2= 75.3%), preoperative pain (MD -1.67; 95% CI -2.50; -0.48, I2= 0%) and risk of fall (MD -2.54; 95% CI -3.62; -1.46, I2= 0%) and postoperative stiffness (MD -2.00; 95% CI -2.01; -1.99, I2= 87%).

Conclusions:

Prehabilitation delivered with advanced technologies proved to be better than standard care in improving pre- and postoperative function for candidates to knee or hip arthroplasty. No quantitative results have been achieved on spine surgery candidates or other musculoskeletal diseases. Clinical Trial: PROSPERO registration number CRD42022345811.