The Effectiveness of Prehabilitation on Postoperative Recovery From Lumbar Spinal Stenosis Surgery: A Systematic Review and Intervention Component Analysis

Sources of Funding: This work was funded by the NIHR Programme Development Grant (NIHR 205671). LW, SEL and EW have also been supported by the NIHR Exeter BRC. Conflicts of Interest: No conflicts of interest Purpose To evaluate prehabilitation interventions evaluated in randomised controlled trials for people undergoing lumbar spinal stenosis surgery and determine which individual intervention components are associated with successful interventions. Methods English language papers from 2011 until December 2025 from PubMed, Cumulative Index of Nursing and Allied Health, Scopus and Web of Science. We searched for randomised controlled trials comparing prehabilitation to other non-active interventions for people undergoing surgery for lumbar spinal stenosis. Two authors independently screened, selected and performed quality assessments of the studies. Relevant study details were extracted, tabulated and synthesised using intervention component analysis. Results Nine papers describing five randomised control trials involving 466 participants and 28 outcomes measured pre- and/or post-surgery were found. Overall, the interventions consisted of 47 individual components. Fifteen of these components (including psychological/behavioural approaches, and cardiovascular, strength and trunk/core exercise) featured in successful interventions that resulted in greater improvement in 16 outcomes (including back pain, disability, walking and hospital stay) in prehabilitation compared to usual care participants. The results of further evaluation of individual outcomes at each time point was inconsistent and unreliable. Conclusion Only five small trials of low-to-moderate quality report common outcomes at similar timepoints. There is high uncertainty regarding the importance of individual intervention components in successful prehabilitation interventions for people undergoing lumbar spinal stenosis surgery.