Prehabilitation for spine surgery: A scoping review

Abstract

We aimed to identify and describe the current interventions used in preoperative programs (“prehabilitation”) for spine surgery. Knowledge gaps in approaches, feasibility, timing, patient experience, clinical outcomes, and health care costs were explored while describing their potential benefits on physical and psychological outcomes. An electronic search was conducted from January 2004 to February 2022 in Ovid Medline, Embase, EBSCO CINAHL, the Cochrane Database of Systematic Reviews, and PEDro to identify studies in English evaluating adults enrolled in prehabilitation before undergoing elective spine surgeries. Studies were uploaded into DistillerSR for systematic screening after removing duplicates. Four reviewers screened nested references for inclusion based on titles and abstracts, followed by their full‐text review. Two reviewers subsequently extracted data and summarized the results. The results were reported using Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews guidelines. Studies were rated for quality using National Health and Medical Research Council criteria. Out of 18,879 potential studies, a total of 23 studies (0.12%) met the eligibility criteria and were included in this scoping review. The prehabilitation programs included general education (n = 6, 26%), exercise (n = 6, 26%), cognitive behavioral therapy (n = 3, 13%), pain neuroscience education (n = 3, 13%), health behavior counseling (n = 3, 13%), and mindfulness (n = 2, 9%). Additional studies are needed to identify optimal patient characteristics, intervention dosage, and whether multimodal approaches using a combination of physical and psychological strategies lead to more favorable outcomes. Although studies on prehabilitation for spine surgery are limited, they seem to demonstrate that prehabilitation programs are feasible, reduce medical expenditures, and improve patients' postoperative pain, disability, self‐efficacy, psychological behaviors, and satisfaction with surgical outcomes. The available literature suggests there is an opportunity to improve patient experience, clinical outcomes and reduce medical costs with the use of prehabilitation in spine surgery.

An evidence based conceptual framework for the multifactorial understanding of proximal junctional kyphosis

“…Similarly, although many patients undergo some form of conservative management prior to surgical authorization, this management is often designed for pain control (e.g. injections, pharmacological pain management, education, or bracing), and the concept of “prehabilitation” with a focus on improving health of the paraspinal muscles around the boundaries of the planned surgical construct is not typical ( Eubanks et al, 2023 ), despite evidence suggesting its efficacy. Generally, reducing PJK risk may require a more intentional peri-operative management strategy that incorporates specific non-surgical management to optimize tissue health pre- and postoperatively - as directed by the surgeon in accordance with the planned surgical procedure.…”

Variables associated with nonresponders to high‐frequency (10 kHz) spinal cord stimulation

“…have suggested the use of a kinesiophobia program involving a workbook about fear of movement management, education, social support, and monthly follow‐up visits. Prehabilitation programs prior to spine surgery have demonstrated improvements in postoperative pain, disability, self‐efficacy, psychological behaviors (such as catastrophizing and kinesiophobia), and satisfaction with surgical outcomes 139 . Pain neuroscience education (PNE) programs utilize a multidisciplinary model, which may include in‐person or virtual personalized or group sessions, either in single or multiple sessions “boot camp” model with a minimum of 4‐h of patient education, in addition to exercise training 140 .…”

“…Prehabilitation programs prior to spine surgery have demonstrated improvements in postoperative pain, disability, self-efficacy, psychological behaviors (such as catastrophizing and kinesiophobia), and satisfaction with surgical outcomes. 139 Pain neuroscience education (PNE) programs utilize a multidisciplinary model, which may include in-person or virtual personalized or group sessions, either in single or multiple sessions "boot camp" model with a minimum of 4-h of patient education, in addition to exercise training. 140 PNE aims to explain to the patient the biological and physiological processes involved in the experience of pain, and more importantly, not to focus on issues related to changes in anatomy or structure.…”

Innovative treatment formats, technologies, and clinician trainings that improve access to behavioral pain treatment for youth and adults

“…Those utilizing emergency services for pain are more likely to have worse chronic pain and psychological wellbeing ( 94 ). Few hospital settings offer pain education or behavioral pain care prior to or following surgical procedures, even though there is evidence that brief behavioral interventions can lower healthcare expenditures and improve surgical outcomes ( 95 ). Primary barriers include poor insurance coverage, high out-of-pocket costs, and the lack of flexible, patient-centered treatments that can scale within these settings ( 96 ).…”