Interventions delivered to orthopaedic patients:
Three out of four preoperative acupuncture interventions (Haslam 2001; Tillu et al. 2002; Williamson et al. 2007) showed significant improvements in measures of physical function in patients on waiting lists for orthopaedic surgery. Measures for physical function included a 5range of condition-specific self-report tools and physical tests. One of the studies (Williamson et al. 2007; weak quality), showed an immediate post-intervention improvement in Oxford Knee Scores (OKS), but this improvement was not sustained after six weeks, or three months post-operatively. The remaining two studies which showed a significant improvement preoperatively (Haslam 2001; Tillu et al. 2002) did not measure the effect at any post-surgical timepoints. The fourth study (Soni et al. 2012; moderate quality) showed that combining acupuncture and group physiotherapy preoperatively had no significant effect on knee function and walking ability.
The four preoperative acupuncture interventions also provided mixed evidence of effectiveness for reducing pain. One found significant reductions in preoperative pain for patients undergoing six-weeks of acupuncture (Tillu et al. 2002; weak quality). However, a similar intervention (Williamson et al. 2007; weak quality), and a longer intervention which also included physiotherapy (Soni et al. 2012; moderate quality), did not show the same effect. The final study (Haslam 2001; moderate quality) showed that patients receiving acupuncture reported fewer symptoms of localised preoperative pain and reduced their analgesia intake, although a similar trend was found for the control group and statistical significance was not reported.
One preoperative intervention that targeted behaviour change through education and psychological techniques (Berge et al. 2004; moderate quality) found no significant improvements in physical disability and pain distress preoperatively.
A behaviour change intervention that targeted education and psychological techniques significantly reduced pain intensity, pain distress, and sleep disturbance in patients with osteoarthritis on a waiting list for total hip replacement (Berge et al. 2004; moderate). These improvements were sustained 12 weeks after the intervention ended. There was no difference in analgesic drug intake between the groups.
An acute prehabilitative neuromuscular exercise-conditioning (APNEC) intervention (Risso et al. 2022; weak quality) significantly increased knee extensor muscular activation capacity and strength. The effects remained up to the day of surgery, one-week following the end of the intervention.
A supervised group exercise programme had no significant effect on OKS scores, health status or walking ability (Williamson et al. 2007; weak).
Interventions on cardiac patients:
Two strong quality preoperative nurse-led interventions that combined education and psychological techniques showed mixed effectiveness of outcomes. McHugh et al. (2001) found significant improvements in BMI, total cholesterol, blood pressure, and health-related quality of life in the intervention group. However, there was no significant change in the proportion of patients in each group exceeding target values for high cholesterol and high diastolic blood pressure (DBP). Goodman et al. (2008) found significant within-group post intervention differences for blood pressure and total cholesterol, but not for quality of life, HDL cholesterol, blood glucose, or BMI. When compared with changes in the control group, all reductions in cardiac risk factors were non-significant.
A further education and psychological intervention called the HeartOp programme (Furze et al. 2009; moderate quality) improved physical functioning in patients undergoing cardiac surgery. It consisted of a nurse-facilitated program that included counselling, goal setting, dispelling cardiac misconceptions and a relaxation program.
Three preoperative exercise interventions showed mixed effectiveness for cardiorespiratory 6fitness outcomes (2 moderate quality, 1 weak quality). Patients undergoing a supervised exercise intervention (Barakat et al. 2014; Barakat et al. 2016) demonstrated significant improvements in VO2 peak, anaerobic threshold, and exercise test endurance. However, VE/VCO2, VE/VO2 and time spent at anaerobic threshold remained unchanged (Barakat et al. 2014; moderate). Preoperative high-intensity training (Tew et al. 2017; moderate) had no significant effect on cardiorespiratory fitness or health-related quality of life. Pain outcomes were not reported in any of the included studies on cardiac patients.