Efficacy of exercise-based prehabilitation for patients undergoing elective spinal surgery: a systematic review and...

The study aimed to investigate the efficacy of exercise-based prehabilitation for preoperative and postoperative outcomes in patients undergoing elective spinal surgery.

A total of five databases were searched from their inception to March 2025 with no date restrictions. Standardized mean differences (SMDs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random effects models. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

In total, six studies with 365 participants were included in this study. Preoperative (after prehabilitation): Exercise-based prehabilitation produced modest improvements compared to controls for back pain (SMD -0.32, 95% CI -0.54 to -0.11; I ² = 0%; GRADE: moderate), leg pain (SMD -0.43, -0.79 to -0.08; I ² = 53%; GRADE: moderate), knee extensor strength (SMD 0.33, 0.07 to 0.58; I ² = 0%; GRADE: moderate), disability (SMD -0.44, -0.65 to -0.23; I ² = 0%; GRADE: moderate), kinesiophobia (SMD -0.30, -0.53 to -0.07; I ² = 0%; GRADE: moderate), and depressive symptoms (SMD -0.24, -0.47 to -0.01; I ² = 0%; GRADE: moderate). Health-related quality of life (HRQoL) favored prehabilitation, but the CI included no effect (SMD 0.51, -0.04 to 1.07; I ² = 71%; GRADE: moderate). Postoperative short-term results (≤1 month): Early back pain improved (SMD -0.51, -0.93 to -0.08; I ² = 36%; GRADE: moderate). One trial reported improved short-term HRQoL. Moreover, length of hospital stay (days) was shorter but not statistically significant (MD -1.30 days, -2.89 to 0.29; I ² = 77%; GRADE: low). Other short-term, intermediate-term (1-6 months), and long-term (≥6 months) results: Pooled estimates for back pain, leg pain, disability, kinesiophobia, depression, and HRQoL clustered near the null, with moderate-certainty evidence for most outcomes and no consistent durable benefit.

Exercise-based prehabilitation provides consistent small-to-moderate standardized benefits for most preoperative outcomes and shows a favorable signal for early postoperative back pain in adults undergoing elective spinal surgery. However, evidence for sustained intermediate- and long-term postoperative improvements is not established with current data.

CRD420251120535, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251120535.