Objective To analyze the perioperative efficacy of enhanced recovery after surgery (ERAS) in the treatment of lumbar disc herniation using unilateral biportal endoscopy technique. Methods A total of 55 patients who received unilateral biportal endoscopy technique for the treatment of lumbar disc herniation in Tianjin Hospital between January and December 2020 were selected and randomly divided into the traditional group and the ERAS group according to random number table method. The routine inpatient care management was adopted in the traditional group, while the holistic integrated care plan was formulated in the ERAS group according to the multidisciplinary collaboration of the accelerated rehabilitation plan. The first postoperative exhaust time, the first time out of bed, length of hospital stay, hospital costs, Visual Analogue Scale (VAS) scores before operation, one day and three days after operation, Oswestry Disability Index (ODI) scores before operation and one month after operation, and the excellent and good rate of modified MacNab efficacy one month after operation were compared between the two groups. Results There were 28 cases in the traditional group and 27 cases in the ERAS group. The first postoperative exhaust time [(2.31±1.02) vs. (3.19±0.87) h], the first postoperative ambulation time [(1.06±0.40) vs. (2.00±0.53) d], length of hospital stay [(3.8±0.8) vs. (4.6±0.8) d], and hospital cost [(32.18±9.10) thousand yuan vs. (39.81±11.10) thousand yuan] in the ERAS group were all less than those in the traditional group, and the differences were statistically significant (P<0.05). The VAS scores of the ERAS group one day after operation (3.2±0.8 vs. 4.1±0.8) and three days after operation (1.4±0.5 vs. 1.7±0.5) were lower than those of the traditional group (P<0.05). The ODI scores of the ERAS group one month after operation was lower than that of the traditional group (13.3±4.0 vs. 16.6±4.8, P<0.05). In the modified MacNab efficacy evaluation one month after surgery, there was no significant difference in the excellent and good rate between the ERAS group and the traditional group (96.3% vs. 96.4%, P>0.05). Conclusions ERAS regimen can significantly accelerate the patients’ recovery, including shortening the first exhaust time, facilitating early ambulation, and reducing the hospital stay and hospitalization expenses. Meanwhile, ERAS regimen can effectively reduce the postoperative pain of the patients, and promote early functional recovery.
Objective To systematically review the efficacy of preoperative rehabilitation for patients with total knee replacement. Methods Electronic databases including The Cochrane Library, EMbase, PubMed, CBM, CNKI and WanFang Data were searched to collect randomized controlled trials (RCTs) about preoperative rehabilitation for total knee replacement from inception to January 2017. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then RevMan 5.3 software was used to perform meta-analysis. Results A total of 13 RCTs involving 745 patients were included. The results of meta-analysis showed that, the TUG scores (6 weeks: MD=–1.31, 95%CI –2.29 to –0.32, P=0.009; 3 months: MD=–1.59, 95%CI –2.03 to –1.15, P<0.000 01), 3 months knee flexion ROM scores (MD=4.75, 95%CI 0.63 to 8.86, P=0.02) in the preoperative rehabilitation group were higher than those in the control group. The 3 months VAS scores (MD=–0.95, 95%CI –1.70 to –0.20, P=0.01) in the preoperative rehabilitation group was lower than that in the control group. There were no statistical differences between two groups in WOMAC scores (MD=–5.61, 95%CI –12.84 to 1.62, P=0.13), SF-36 scores (MD=13.15, 95%CI –10.51 to 36.81, P=0.28), knee extension ROM scores (6 weeks: MD=0.60, 95%CI –1.02 to 2.21, P=0.47; 3 months: MD=–2.76, 95%CI –8.45 to 2.92, P=0.34), HSS scores (MD=0.54, 95%CI –0.46 to 1.54, P=0.29), and 6 minutes test scores (MD=–8.75, 95%CI –51.53 to 34.03, P=0.69). Conclusion Current evidence shows that preoperative rehabilitation can improve the postoperative knee function after operation and significantly reduce the pain. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.
Informed-evidence decision-making (IEDM) has emerged as the predominant principle of providing guidance for policy-making and practice, however, the best available evidences requisite of performing successfully IEDM. Different forms of evidence and different kinds of review questions call for the development of new approaches that are designed to more effectively and rigorously identify and synthesize the evidence. Fourteen methods of reviewing literature have been recently used to identify and synthesize evidence, of which scoping reviews is increasing popular. This article introduces aspects such as background, purpose and methodological frame work and explains the process of it with an example so that facilitating the dissemination and utilization of scoping review in China.