プレハビリテーションのメタ解析

プレハビリテーションのメタ解析の論文を紹介します。

D. Santa Mina, et al. Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy, http://dx.doi.org/10.1016/j.physio.2013.08.008

成人外科患者に対するプレハビリテーションの系統的レビューとメタ解析です。結果ですが、系統的レビューではプレハビリテーションで術後疼痛、入院期間、身体機能は改善しましたが、健康関連QOL、生命予後、有酸素能力は一貫した結果ではありませんでした。

メタ解析では、術後の入院期間が有意に短縮しました。これよりプレハビリテーションは入院期間短縮と術後の身体機能改善に有用な可能性がありますが、論文の質が中～低いためバイアスの可能性があるという結論です。

整形外科領域でのプレハビリテーションは賛否両論のところがありますが、外科領域でのプレハビリテーションは有用なようです。今後はどのようなプレハビリテーション介入（例えば運動＋栄養＋心理）がより有用かの検証が重要と思われます。

Abstract

Objective

To systematically review the evidence of pre-operative exercise, known as ‘prehabilitation’, on peri- and postoperative outcomes in adult surgical populations.

Design

Systematic review and meta-analysis.

Data sources

CENTRAL, Medline, EMBASE, CINAHL, PsycINFO and PEDro were searched from 1950 to 2011.

Methods

Two reviewers independently examined relevant, English-language articles that examined the effects of pre-operative total-body exercise with peri- and postoperative outcome analysis. Given the nascence of this field, controlled and uncontrolled trials were included. Risk of bias was assessed using the Cochrane Risk of Bias Assessment tool. Only data on length of stay were considered eligible for meta-analysis due to the heterogeneity of measures and methodologies for assessing other outcomes.

Results

In total, 4597 citations were identified by the search strategy, of which 21 studies were included. Trials were generally small (median = 54 participants) and of moderate to poor methodological quality. Compared with standard care, the majority of studies found that total-body prehabilitation improved postoperative pain, length of stay and physical function, but it was not consistently effective in improving health-related quality of life or aerobic fitness in the studies that examined these outcomes. The meta-analysis indicated that prehabilitation reduced postoperative length of stay with a small to moderate effect size (Hedges’ g = -0.39, P = 0.033). Intervention-related adverse events were reported in two of 669 exercising participants.

Conclusion

The literature provides early evidence that prehabilitation may reduce length of stay and possibly provide postoperative physical benefits. Cautious interpretation of these findings is warranted given modest methodological quality and significant risk of bias.