Postoperative physiotherapy in enhanced recovery pathways: A general surgery evidence update, dominated by colorectal studies.

Abstract

Introduction: Physiotherapy is a pivotal component of enhanced recovery protocols, particularly in initiating early mobilisation and supporting the return to functional independence. Despite this, there is a lack of guidance on optimal post-mobilisation physiotherapy strategies. This systematic review aims to synthesise and critically appraise the most recent evidence on postoperative physiotherapy interventions within enhanced recovery pathways for general surgical patients. This review seeks to advance scientific understanding and provide guidance for the optimisation of physiotherapy practice within enhanced recovery pathways. Materials and methods: A systematic review of the literature between 2000 and 2024 was conducted to identify studies of physiotherapy interventions in general surgical populations following an enhanced recovery protocol. Results: Ten studies met the inclusion criteria. Six studies were conducted in colorectal patients, one study (plus a secondary analysis) was conducted in radical cystectomy patients, one in head and neck patients undergoing oncologic resection, and one included a mixed patient sample (colon, rectum, stomach, pancreas and liver surgery). Interventions involving early physiotherapy were found to benefit postoperative walking distance, achievement of activities of daily living and length of stay in hospital. There was mixed evidence for influence on readiness for discharge, quality of recovery measures and health-related quality of life. No consistent effects were observed for inpatient satisfaction or functional outcome. Conclusion: This review supports the feasibility and potential benefits of a structured physiotherapy interventions within enhanced recovery protocols. These results highlight the potential for structured mobilisation interventions to enhance recovery, particularly when supported by education and technology-based strategies.