Feasibility of conducting an active exercise prehabilitation program in patients awaiting spinal stenosis surgery: a randomized pilot study

Abstract

Prehabilitation is defined as the process of augmenting functional capacity before surgery in preparation for the postoperative phase. This study intends to assess the feasibility of conducting a preoperative intervention program in patients with lumbar spinal stenosis and to report on the piloting of the proposed intervention. Patients were allocated to a 6-week supervised preoperative rehabilitation program or a control group. The intervention included supervised exercise sessions aimed to improve strength, muscular endurance, and spinal stabilization. Outcomes were measured at baseline, 6 weeks later and again 6 weeks, 3 months and 6 months after surgery. Sixty-five percent of admissible participants agreed to take part in the study, of which 5% dropped out before the end of the intervention period. Eighty-eight percent of potential training sessions were delivered without adverse event. Improvements were seen in favour of the experimental group at the preoperative assessment for active ranges of motion, leg pain intensity, lumbar extensor muscle endurance and walking capacities. Results show that slight modifications to the choice of outcome measures would increase feasibility of the main study. The absence of adverse events coupled with positive changes seen in dependant outcome measures warrant the conduct of a full-scale trial assessing the effectiveness of the intervention.

Effectiveness of an exercise-based prehabilitation program for patients awaiting surgery for lumbar spinal stenosis: a randomized clinical trial

“…Enrollment started in February 2015, with the last follow-up in February 2020. The trial protocol 22 as well as the feasibility and pilot results 23 have been published elsewhere. The study received ethical approval from the institutional review board of UQTR (CÉR-2014-008-00) and was registered in ClinicalTrials.gov (NCT02258672; October 7th, 2014).…”

“…Exercise intensity level was individually tailored to the participants’ capacity and progressively modified to provide increasing levels of difficulty. For a full description of the exercise intervention, see previous reports 22 , 23 . Adherence to the exercise program was documented in the kinesiologist logbook.…”

“…Based on results from the pilot study 23 , physical tests better reflecting patients’ activities of daily living were deemed necessary to capture functional capacities as oppose to physiological changes to exercise. As such, in the main trial, we included the 30 s sit-to-stand 34 and the timed up and go 35 tests that allowed for the measurement of progress regarding balance, sit to stand, and short-distance walking capacities.…”

“…The sample size calculation for the main trial was conducted using the pilot study’s means and standard deviations for leg pain intensity 23 (measured after the 6-week prehabilitation intervention), assuming a one-tailed test and considering a significance level of p = 0.01, a power of 90%, and a 20% attrition rate. An estimated 36 patients per treatment arm were required to detect a significant between-group difference.…”

“…Participants were not blinded to intervention allocation, but to prevent cross-contamination between groups content of exercise sessions was known only to those in the intervention group. Further details about randomisation, minimization and blinding are published elsewhere 22 , 23 .…”