Three moderate quality randomised controlled trials published across five papers(13-17) examined prehabilitation exercise interventions consisting of both supervised and self-directed elements. One randomised controlled trial each took place in patients awaiting total knee replacement(16, 17), total hip replacement (14, 15) and high tibial osteotomy or prosthetic knee replacement(13).
The interventions lasted between five and eight weeks and all consisted of both clinic-based supervised sessions and home-based self-directed exercises. The control groups consisted of usual care(14-17) or no intervention(13). Exercises generally aimed to improve strength, flexibility, and range of motion.
There is moderate quality evidence to suggest that exercise prehabilitation interventions where components consist of both supervised and self-directed elements, for patients on orthopaedic surgical wait lists, are likely to be ineffective for the following outcomes:
Pain:
Might not be effective (three moderate quality studies showing no effect for the intervention compared to control)(13, 15, 16).
The evidence of effectiveness for exercise prehabilitation interventions where components consist of both supervised and self-directed elements, for patients on orthopaedic surgical wait lists, is inconsistent for the following outcomes:
Function:
Inconsistent (three studies; moderate quality, inconsistent effects across studies)(13, 15, 16).
Muscle strength:
Inconsistent (three studies; moderate quality, inconsistent effects across studies)(13, 15, 16).
Range of Motion outcomes:
Inconsistent (two studies; moderate quality, inconsistent effects across studies)(13, 15).
The evidence of effectiveness exercise prehabilitation interventions where components consist of supervised and self-directed elements, for patients on orthopaedic surgical wait lists, is lacking for the following outcomes:
Health status:
Might be effective (one moderate quality study showing significant effect for the intervention compared to control)(14).
Stiffness:
Might be effective (one moderate quality study showing significant effect for the intervention compared to control)(14).
Gait Speed:
Might not be effective (one moderate quality study showing no effect of the intervention on gait performance compared to control)(13).
Delay or cancellation of surgery:
One strong quality study showing two participants in the intervention group decided to delay/cancel surgery because of marked improvements in physical function and reduction in pain(14)
The randomised controlled trials were conducted in Australia(14, 15), Sweden(13) and USA(16, 17). Therefore, generalisability to the Welsh context should be considered.
The interventions all took place in patients waiting for various orthopaedic surgeries and therefore may not be applicable to patients waiting for other elective surgeries.
It is suggested that further robust research and thorough evaluation of impact is needed.