Prehabilitation for Spine Surgery – what works?

Spinal disorders are one of the most disabling and costly health issues and sometimes, surgery is necessary. A growing body of research suggests that physical and psychological factors are associated with important clinical and economic outcomes following spine surgery. In fact, when predicting clinical outcomes following lumbar spinal stenosis surgery, demographic, health, and clinical factors may play a more important role than the surgical factors! This may be a result of patients who have undergone surgery often reporting reduced physical activity, pain catastrophizing behavior, poor self-efficacy and fear avoidance beliefs.
 
Prehabilitation (also called prehab) offers an opportunity to assess the patient pre-operatively and address physical limitations, fear avoidance beliefs and low self-efficacy that may infer better recovery following surgery. Prehab aims to prepare patients for surgery by enhancing their intrinsic abilities to overcome functional post-operative declines and improve satisfaction by aligning expectations with capabilities.
 
Despite the growing evidence in the prehab literature (for knee and hip OA, for example), the effectiveness of a comprehensive multimodal prehab program in the field of spine surgery remains unknown.
 
The primary aim of this scoping review was to identify and synthesize information about current interventions in prehab programs for spine surgery. The authors aimed to explore knowledge gaps in approaches, feasibility, timing, patient experience, clinical outcomes and healthcare costs, as well as potential effectiveness of prehab on physical and psychological outcomes.

From Dr. Thistle:

“Unfortunately, our care cannot always prevent progression of a patient’s spinal condition to the point where surgery becomes the best option. However, that doesn’t mean we cannot play a role along the way, from facilitating appropriate referral when their clinical condition dictates, to relevant prehab and rehab interventions to keep them as functional and fit as possible going into, and after, their surgical procedure.“

RESEARCH REVIEW: Prehabilitation for Spine Surgery – Evidence Overview

This paper was published in PM R (2023). 

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