The effectiveness of prehabilitation on post-operative recovery from lumbar spinal stenosis surgery - A systematic review and intervention component analysis.

Only five trials were included, and one pilot study was not used in the outcome syntheses because it was not powered for hypothesis testing. Only two trials specifically evaluated prehabilitation in lumbar spinal stenosis, while three trials involved various degenerative spinal conditions. The sample sizes were generally small, and one trial did not recruit to target. Dropout was high in some trials, including 22% overall and 27% in the prehabilitation group at three months, and 29% overall and 37% in the prehabilitation group at 12 months. Risk of bias was not low: four trials had some concerns overall and one had high risk due to lack of blinding of principal investigators. Intervention reporting was poor, with details about training, rationale, modifications and clinician experience least well reported. Prehabilitation programmes contained multiple components at once, and two trials gave extra post-operative care to the prehabilitation arm, so the effect of any single component cannot be separated. The component analysis used a 50% threshold that lacks evidence, and adding or removing one trial could change the result. Between-group differences were often short term and may not be clinically relevant. Only two trials measured outcomes beyond six months after surgery. The review included only English language papers and did not search unpublished or grey literature.

The authors received funding from the National Institute for Health and Care Research, and some authors are supported by an NIHR Biomedical Research Centre. The authors declared no potential conflicts of interest.

Do not read the 15 components as a proven recipe for prehabilitation. They came from four trial interventions with small samples, mixed conditions, dropouts, and low confidence. The authors say these findings are highly likely to change with new evidence.