Preoperative home physical therapy for the prevention of postoperative complications in fragile older adults

Abstract

Introduction: In older adults undergoing major elective surgery, frailty has emerged as a significant negative prognostic factor. In this context, preoperative home-based physical therapy has been investigated as a strategy to improve postoperative functional recovery. Objective: To analyze the effects of preoperative home-based physical therapy on postoperative complications and functional recovery in frail older adults undergoing major elective surgery. Methods: This meta-analysis was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020). Three randomized controlled trials involving frail older adults undergoing major elective surgery were included. Relative risk with 95% confidence intervals (95% CI) was used for dichotomous outcomes, and mean difference or standardized mean difference was used for continuous outcomes, as applicable. Results: Random-effects meta-analysis did not show a significant reduction in overall postoperative complications with prehabilitation (RR = 0.97; 95% CI, 0.78 to 1.20; I² = 38.4%) or a statistically significant reduction in the 30-day Comprehensive Complication Index (MD = -3.52; 95% CI, -8.02 to 0.99; I² = 0.0%). Conversely, functional recovery at 4 weeks was more frequent among patients assigned to prehabilitation (RR = 1.34; 95% CI, 1.02 to 1.75; I² = 0.0%). Conclusion: Prehabilitation appears to be safe and potentially useful for functional recovery in frail older adults, but the available evidence remains limited and heterogeneous, with no consistent demonstration of reduced overall postoperative complications.