The Effect of Prehabilitation, Perioperative, and Postoperative Physiotherapy on Postoperative Outcomes in Adults Undergoing Laparoscopic Surgery: A Systematic Review

Objective To determine the effectiveness of physiotherapy interventions for patients undergoing laparoscopic abdominal surgery on postoperative outcomes and the optimal frequency, timing, and type of intervention. Methods A literature search was performed in AMED, MEDLINE, CINAHL, Scopus, and Web of Science from 2009 to 2023. Randomised controlled trials (RCTs) that examined pre-operative and/or post-operative physiotherapy interventions on adults undergoing laparoscopic abdominal surgery were included. Intervention characteristics, outcome measures, and results were extracted. A tabulated summary and narrative discussion were generated to compare similarities and differences across each study. Results From 3811 studies identified, 9 RCTs met inclusion criteria. Preoperative incentive spirometry (IS) alone or with inspiratory muscle training (IMT) showed no postoperative pulmonary complications (PPCs) but had mixed effects on pulmonary function. Perioperative breathing interventions reduced PPCs, length of stay, and hospital costs. Trials on prehabilitation or postoperative IS found no significant PPC differences. However, prehabilitation, deep breathing exercises, IS, and mobilisation with chest physiotherapy improved pulmonary function. Mobilisation, preoperative IS, and perioperative breathing also enhanced arterial blood gas (ABG) results. Six-minute Walk test distances increased with prehabilitation, perioperative breathing, and mobilisation with chest physiotherapy. All trials had a high risk of bias, with PEDro scores of 5–8/10, indicating “fair” to “good” quality. Conclusion Perioperative breathing was the only intervention shown to reduce PPC rates. Prehabilitation, deep breathing exercises, IS, and mobilisation with chest physiotherapy improved pulmonary function. Larger, well-designed RCTs are needed to confirm the effectiveness of these interventions. PROSPERO (registration ID: 529588).