What is the Current Evidence Base for Post-Operative Physiotherapy in General Surgical ERAS Pathways?

Abstract

Objectives: Enhanced Recovery after Surgery (ERAS) has improved outcomes following elective surgery. Physiotherapy has traditionally played an important role in the surgical pathway, and a major advance in ERAS has been the introduction of early mobilisation. However, changes in other post-operative physiotherapy interventions have been less apparent. This systematic review aimed to assess the current evidence for post-operative physiotherapy interventions deployed in general surgical pathways that reported adherence to ERAS principles. Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A computer-based search was completed in September 2017, and the electronic databases sourced included: PubMed, Cochrane Library, CINAHL Complete and Medline Complete. Randomised controlled trials (RCTs) that compared physiotherapy interventions for patients following general, elective ERAS procedures were included. Orthopaedic surgeries were not included within the search due to the nature of procedure and already published literature in this area. Results: One study was found to compare post-operative physiotherapy interventions in a cohort of radical cystectomy patients on an ERAS pathway. The authors found fast-track surgery with the addition of a progressive exercise based intervention to improve patient outcomes with no increase to severity of complications. Conclusion: It is essential that the paucity of research to assess post-operative physiotherapy interventions within ERAS cohorts following general, elective surgery is highlighted and exposed. Physiotherapy is a central tenet of the rehabilitation journey. It is possible that evidence-based post-operative physiotherapy interventions are being used in ERAS cohorts; however this practice is not reported within the literature. Without well-conduced RCTs to evaluate procedure-specific physiotherapy interventions, the optimal type, timing, and dose will not be found, and the potential for improving patient functional recovery will likely be limited.