The Added Value and the Efficacy of Preoperative Physiotherapy on Degenerative Diseases of the Lumbar Spine: A Systematic Review

Background and Purpose: Degenerative Diseases of the Lumbar Spine (DDLS) are typically managed with conservative treatments, while surgery is reserved for cases with severe motor and/or sensory deficits. Preoperative physiotherapy has been shown to improve postoperative outcomes in shoulder, hip, and knee surgeries. However, its effects on the lumbar spine have been poorly investigated. This systematic review aimed to evaluate the efficacy of preoperative physiotherapy on pain, disability, and hospitalisation in individuals with DDLS. Methods: A literature search was conducted in MEDLINE, Cochrane CENTRAL, Scopus, PEDro and EMBASE. Two reviewers independently screened the studies, extracted the data, and assessed the risk of bias. We included randomised controlled trials (RCTs) in which preoperative interventions were delivered by physiotherapists and compared to usual care or other interventions. We conducted meta-analyses on primary outcomes. Results: We screened 9.803 studies and included 6 with 5 different study populations. All studies were RCTs that evaluated the efficacy of preoperative physiotherapy compared with usual care in pain and disability. The preoperative interventions were heterogeneous, varying between therapeutic exercise, cognitive-behavioural therapies, and multimodal interventions. The meta-analyses showed no difference between interventions. All studies had a high risk of bias. Conclusion: The effects of preoperative physiotherapy, compared with usual care, on pain, disability, and hospitalisation among patients with DDLS, are minimal. However, the risk of bias of the included studies and the certainty of evidence, based on the GRADE approach, were very low. Future high-quality, low-bias trials are needed to clarify its effectiveness and identify patient subgroups that may benefit the most.