Perioperative Exercise and Physical Therapy in Abdominal Free Flap Breast Reconstruction: A Systematic Review
Amanda L. Chow, BA1,2, Sai Pinni, BS1,3, Jonlin Chen, BS1, Alexander Karius, BS1, Carisa M. Cooney, MPH1, Kristen P. Broderick, MD1
1Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; 2Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ; 3Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO
Background: Prehabilitation and postoperative physical therapy have been shown to improve outcomes following major abdominal surgery by decreasing recovery times and improving patient satisfaction. The purpose of this study was to conduct a systematic review to summarize perioperative exercise and physical therapy (PT) regimens for abdominal-based free flap breast reconstruction and their outcomes.
Methods: A systematic review of all studies on perioperative exercise and physical therapy regimens in patients undergoing abdominal-based free flap breast reconstruction was performed using PRISMA guidelines. Six databases were queried for randomized clinical trials, cohort studies, case-control studies, and case series with n ? 10 published in English that evaluated perioperative physical activity in abdominal-based free flap breast reconstruction. Two reviewers completed screening, data extraction, and quality assessment. Methodological quality was evaluated using Newcastle-Ottawa scale, JBI Critical Appraisal Checklist, and Cochrane Risk of Bias. Outcomes of interest were type of regimen, duration, and measures used to evaluated effects of perioperative regimens.
Results: A total of 296 articles were identified through literature search. Perioperative Exercise and Physical Therapy in Abdominal Free Flap Breast Reconstruction: A Systematic Review and abstract screening revealed 16 studies for full-text screening. Six articles met the inclusion criteria for qualitative analysis, comprising of one randomized clinical trial, three prospective cohort studies, one retrospective cohort study, and one cross-sectional survey. Three studies assessed preoperative exercise regimens, while both postoperative regimen studies evaluated both exercise and PT. Two of the studies assessing exercise regimens specifically focused on abdominal strength training. Study outcomes included satisfaction (n=2), postoperative complications (n=1), abdominal muscle strength (n=3), and postoperative pain (n=2). The study assessing general satisfaction found that increasing preoperative exercise intensity level led to 1.68 times greater postoperative satisfaction (p=0.03). A randomized controlled trial demonstrated that at one-year follow-up, preoperative abdominal muscle strength training resulted in greater isometric extension in neutral (p=0.017) and in extension (p=0.028) compared to no exercise. Additionally, of patients undergoing unilateral reconstruction, 11% and 27% in the exercise and control group, respectively, reported functional problems or tight abdominal scarring (p=0.102). A cross-sectional survey revealed that 54% of surgeons never or rarely recommended PT, while 56% recommended avoidance of strenuous physical activity for 5-7 weeks. Conclusion:: Our review demonstrates that perioperative exercise and PT regimens may be beneficial to postoperative quality of life, abdominal strength, daily functionality, and satisfaction following abdominal-based breast reconstruction. Nevertheless, the current literature remains sparse, and future studies are needed to elucidate appropriate regimens, duration, ideal candidates, and maximization of postoperative benefits.
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