Relative efficacy of prehabilitation interventions and their components: systematic review with network and component network meta-analyses of randomised controlled trials.

Methods

Systematic reviewwith network and component network meta-analyses of randomised controlled trials.

对随机对照试验进行系统评价，并结合网络和成分网络荟萃分析。

data_sources

Medline, Embase, PsycINFO, CINAHL, Cochrane Library, and Web of Science were initially searched 1 March 2022, and updated on 25 October 2023.

Medline、Embase、PsycINFO、CINAHL、Cochrane Library 和 Web of Science 最初于 2022 年 3 月 1 日进行了搜索，并于 2023 年 10 月 25 日进行了更新。

Certainty in findings were assessed using the Confidence in Network Meta-Analysis(CINeMA) approach.

使用网络荟萃分析的置信度评估方法（CINeMA）对研究结果的确定性进行了评估。

Methods

To compare treatments and to compare individual components informed by partnership with patients, clinicians, researchers, and health system leaders using an integrated knowledge translation framework.

通过与患者、临床医生、研究人员和卫生系统领导的合作，使用综合知识转化框架，比较治疗方案以及个别组成部分。

Eligible studies were any randomised controlled trialincluding adults preparing for major surgery who were allocated to prehabilitation interventions or usual care, and where critical outcomes were reported.

符合条件的研究是任何随机对照试验，包括准备接受主要手术的成年人，他们被分配到术前康复干预或常规护理，并且报告了关键结果。

Results

186 unique randomised controlled trials with 15 684 participants were included.

纳入了186项独特的随机对照试验，共有15,684名参与者。

When comparing treatments using random-effects network meta-analysis, isolated exercise (odds ratio 0.50 (95% confidence interval(CI) 0.39 to 0.64); very low certainty of evidence), isolated nutritional (0.62 (0.50 to 0.77); very low certainty of evidence), and combined exercise, nutrition, plus psychosocial (0.64 (0.45 to 0.92); very low certainty of evidence) prehabilitation were most likely to reduce complications compared with usual care.

在使用随机效应网络荟萃分析比较治疗效果时，单独运动（优势比0.50（95%置信区间（CI）0.39至0.64）；证据确定性非常低）、单独营养（0.62（0.50至0.77）；证据确定性非常低）以及结合运动、营养和心理社会干预（0.64（0.45至0.92）；证据确定性非常低）的术前康复与常规护理相比，最有可能减少并发症。

Combined exercise and psychosocial (-2.44 days (95% CI -3.85 to -1.04); very low certainty of evidence), combined exercise and nutrition (-1.22 days (-2.54 to 0.10); moderate certainty of evidence), isolated exercise (-0.93 days (-1.27 to -0.58); very low certainty of evidence), and isolated nutritional prehabilitation (-0.99 days (-1.49 to -0.48); very low certainty of evidence) were most likely to decrease length of stay.

综合运动和心理社会干预（-2.44天（95%置信区间-3.85至-1.04）；证据确定性非常低）、综合运动和营养干预（-1.22天（95%置信区间-2.54至0.10）；证据确定性中等）、单独运动干预（-0.93天（95%置信区间-1.27至-0.58）；证据确定性非常低）以及单独营养预康复干预（-0.99天（95%置信区间-1.49至-0.48）；证据确定性非常低）最有可能缩短住院时间。

Combined exercise, nutrition, plus psychosocial prehabilitation was most likely to improve health related quality of life (mean difference on Short Form-36 physical component scale 3.48 (95% CI 0.82 to 6.14); very low certainty of evidence) and physical recovery (mean difference in meters on the six min walk test 43.43 (95% CI 5.96 to 80.91); very low certainty of evidence).When comparing individual components using component network meta-analysis, exercise and nutrition were the individual components most likely to improve all critical outcomes.

综合运动、营养以及心理社会预康复最有可能改善与健康相关的生命质量（Short Form-36身体成分量表的平均差异为3.48（95%置信区间0.82至6.14）；证据确定性非常低）和身体恢复（六分钟步行测试中的平均差异为43.43米（95%置信区间5.96至80.91）；证据确定性非常低）。在使用组件网络荟萃分析比较各个组成部分时，运动和营养是单独的组成部分最有可能改善所有关键结果的。

The certainty of evidence for all comparisons across all outcomes was generally low to very low due to trial level risk of bias and imprecision; however, results for exercise and nutritional prehabilitation were robust with exclusion of high risk of bias trials.

所有比较中，由于试验层面的风险偏倚和不精确性，所有结果的证据确定性普遍较低至非常低；然而，排除高风险偏倚试验后，运动和营养预康复的结果是稳健的。

Conclusions

Consistent and potentially meaningful effect estimates suggest that exercise prehabilitation, nutritional prehabilitation, and multicomponent interventions including exercise may benefit adults preparing for surgery and could be considered in clinical care.

一致且可能有意义的效果估计表明，运动预康复、营养预康复以及包括运动在内的多组分干预措施可能对准备手术的成人有益，并且可以在临床护理中考虑。

However, multicentre trials that are appropriately powered for high priority outcomes and that have a low risk of bias are required to have greater certainty in prehabilitation's efficacy.

然而，需要进行适当规模的多中心试验，以确保对高优先级结果的低偏倚风险，并对康复前训练的有效性有更大的确定性。

registration

International prospective registry of systematic reviews CRD42023353710.

国际前瞻性系统评价注册 CRD42023353710。