Post on 16-Mar-2018
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Supplementary table i: Study characteristics
Study ID Participamts Intervention(s) Usual care Outcomes assessed Quality scoreProstate cancerBurgio 2006 [21] Prostate cancer
(awaiting radical prostatectomy)
N=63(N=51 at final follow-up; reasons for loss to follow-up not reported)
Definition:Pelvic floor muscle training (PFMT) and biofeedback
Initiation:Pre-surgery
Content: One session of
biofeedback with PFMT
Daily pelvic floor exercises (45 exercises, 3 sessions to build up gradually to 10 sessions)
N=62(N=51at final follow-up; reasons for loss to follow-up not reported)
Brief verbal instructions at postoperative visit
Post-intervention Seven-day
bladder diary Use of
incontinence pads Time to
continence
Six-week, three- and six-month follow-up
Bladder control Lifestyle issues Health status Distress Incontinence
impact
High risk of bias
Centemero 2010 [28]
Prostate cancer (awaiting radical prostatectomy)
N=59(no losses to follow-up)
N=59(no losses to follow-up)
One- and three-months post-surgery
Self-reported
Low risk of bias
Definition:PFMT
Initiation:30-days pre-surgery
Content: PFMT exercises, visual
biofeedback and verbal instruction and reinforcement.
Twice supervised per week (30minutes) and daily at home (30minutes) for 48-hours after catheter removal until continence was achieved.
PFMT to be undertaken post-operatively as part of standard care
continence. Degree of urinary
incontinence Satisfaction with
preoperative PFMT
Parekh 2003 [16] Prostate cancer (awaiting radical prostatectomy)
N=19(n=1 loss to follow-up, no reason reported)
Definition:PFMT
Initiation:Pre-surgery
N=19 enrolled(N=1 loss to follow-up, no reason reported)
Usual care
Six-, 12-, 16-, 20-, 28- and 52-weeks post-operation
Urinary continence
Frequency of daily pad use.
Median time to continence
High risk of bias
Content: Physical therapy and
pelvic floor muscle training.
Education in pelvic floor muscle awareness.
Two sessions prior to surgery
Every three-weeks post-surgery up to three-months
Up to six-months or more at home post-surgery
Parker 2009 [13] Prostate cancer patients (awaiting radical prostatectomy)
Group 1: Stress Management
N=53 enrolled(n=38 at final follow-up; reasons for loss to follow-up reported)
Initiation:One to two weeks prior to surgery
Content:
N=52 enrolled(N=44 available at follow-up; reasons for loss to follow-up reported)
Usual care
One-week pre-surgery, morning of surgery. six-weeks, six- and 12-months post-surgery
Mood disturbance
One-week pre-surgery, six-weeks, six- and 12-months post-surgery
Impact of events
Six-weeks, six- and 12-
High risk of bias
Guided manual Two 60-90minute
individual sessions with a clinical psychologist.
Training in relaxation and problem-focused coping skills.
Information about prostate cancer, surgery and management of effects.
Two booster sessions
Group 2: Supportive attention
N=54 enrolled(N=45 available at follow-up; reasons for loss to follow-up reported)
Initiation:One to two weeks prior to surgery
Content: Two 60-90minute
sessions with a clinical psychologist who
months post-surgery Quality of life
undertook a detailed psychosocial and medical history with participants.
Two booster sessionsTienforti 2011 [19] Patients with
localised prostate cancer awaiting radical prostatectomy
N=17 enrolled(n=16 available at follow-up, reasons for follow-up reported)
Definition:PFMT
Initiation:One-day pre-surgery
Content: One supervised PFMT
and biofeedback session with a dedicated caregiver
Written and oral instructions on PF muscle contractions
Structured programme of exercises
N=17 enrolled(N=16 available at follow-up, reasons for drop-out reported)
Standard care- verbal and written instruction on PFMT after catheter removal
IV group assessed at each monthly visit post-catheter removal and controls at one-, three- and six-months post-catheter removal
Urinary function/symptoms
Impact of continence
Six-months post-catheter removal
Frequency of incontinence episodes per week
Weekly pad use
Moderate risk of bias
Cohen 2011 [14] Prostate cancer patients (awaiting radical
Same as Parker 2009 [13] Same as Parker 2009 [13]
48hours post-surgery Immunological
markers
High risk of bias
prostatectomy)Lung cancerBenzo 2011a [12] Lung cancer
(resectable) and moderate/severe COPD
N=5(No losses to follow-up)
Definition:Pulmonary rehabilitation
Initiation:Pre-surgery
Content: Exercise guidelines
according to American Thoracic Society
Four weeks, three times per week (two supervised; one unsupervised)
N=4(no losses to follow-up)
Usual care
Hospital length of stay
Post-operative pulmonary complications
Severe atelectasis Prolonged chest
intubation Prolonged
mechanical ventilation
High risk of bias
Benzo 2011b [12] Lung cancer (resectable) and moderate/severe COPD
N=10(1 loss to follow-up, person found to be non-resectable during surgery)
Definition:Pulmonary rehabilitation
N=9(1 loss to follow-up, person found to be non-resectable during surgery)
Usual care
Hospital length of stay
Post-operative pulmonary complications Severe atelectasis
Prolonged chest tubes
High risk of bias
Initiation:Pre-surgery
Content: Lower extremity
endurance exercises, strength exercises
IMT, slow breathing and walking
Five days Ten face to face
sessions, two dailyLai 2016 [17] Non-small cell lung
cancer (awaiting surgery)
N= 30(4 lost to follow-up, reasons include not able to undertake endurance training)
Definition:Exercise-based prehabilitation
Initiation:Pre-surgery
Content : Two daily 15-20
minute sessions of abdominal breathing
Three daily 15-20
N=30(no losses to follow-up)
Usual care
30-day post-operative pulmonary complications
Quality of life and patient symptoms
Functional ability Pulmonary
function
High risk of bias
minute sessions of expiration exercise
One daily 30-minute session of aerobic endurance training.
Licker (2016) [18] Lung cancer stage I-IIIa (awaiting surgery)
N=83 enrolled(losses to follow-up withdrawal n=3 and operation cancelled n=3)
Definition: Exercise- High Intensity Interval TrainingInitiation: time pre-surgery not specifiedContent: Supervised cycling ergometer sessions. Five-minute warm-up at 50% peak work rate. Two 10 minute sets alternate 15-seconds intervals of sprint at 80-100% peak work rate and pause. Four-minute rest period between sets. Five-minute cool-down at 30% peak work rate. Individualised additional exercises added. Risk management and active mobilisation (30-minute daily
N=81(losses to follow-up withdrawal n=5 and operation cancelled n=2)
Risk management and active mobilisation (30-minute daily walking) advised.
Composite morbidity score
Cardiopulmonary function
Post-operative pulmonary complications
Functional ability Length of stay in
post-anaesthetic care unit
Admission to intensive care unit
High risk of bias
walking) advised.Duration: Supervised cycling ergometer sessions 2-3 times per week pre-surgery only.
Pehlivan 2011 [22] Operable lung cancer (stages Ia-IIIb) without major cardiac morbidity
N=30(no losses to follow-up)
Definition:Intensive physical therapy
Initiation:One-week prior to surgery
Content: Breathing exercises Walking on a treadmill
three-times a day and encouraged to walk other times of the day.
N=30(no losses to follow-up)
Usual care
Length of hospital stay (days)
Perfusion distribution
Pulmonary function
Heart rate Recovery rate Distance walked Dyspnea Post-operative
complications
High risk of bias
Stefanelli 2013 (25) Non-small cell lung cancer (stages I-IIa) with COPD less than 75-years old
N in each arm not reported
Definition:Pulmonary Rehabilitation Program
Initiation:Three-weeks pre-operation
N in each arm not reported
Standard care
End of PRP (before surgery) and 60-days post-surgery
Respiratory function
Dyspnea Physical
performance
High risk of bias
Content: Respiratory exercises Upper limb exercises Lower limb exercises Fifteen, one-hour
sessions (three times a day)
Wall 2000 (26) Non-small cell lung cancer (stages I-IIIa)
N=49 completed the study(reasons for loss to follow-up reported)
Definition:Exercise
Initiation:Pre-surgery
Content: Written and practical
instruction of exercises. Sniff and blow
breathing exercises, arm-, leg-, walking- and stairclimbing- exercises
Between one and 20 days
N=48 completed the study(reasons for loss to follow-up reported)
Usual care
Seven to ten days pre-surgery at time of diagnosis (T1), day before surgery and completion of IV (T2), four to six days post-surgery:
Hope Empowerment
High risk of bias
Breast cancer
Burton 1995 [23] Breast cancer (awaiting full or partial mastectomy)
Group 1: Interview and psychotherapeutic intervention
N=51(n=45 at one-year follow-up; reasons for loss to follow-up not fully known)
Initiation:Day pre-surgery
Content: Pre-operation interview
(45 mins) Psychotherapeutic
intervention (30mins: situate current illness and surgery within current life to explore feelings)
Group 2: Interview and ‘chat’ (to control for attention)
N=57(n=46 at one-year follow-up; reasons for loss to follow-up not fully known)
N=53(n=46 at one-year follow-up; reasons for loss to follow-up not fully known)
Usual care
Four-days post-surgery Anxiety Depression
Three-months post-surgery
Anxiety Depression Body image
distress
One-year follow-up Cancer-related
distress Morbidity Coping styles Worry Quality of life Body image
distress Stressful life
events.
High risk of bias
Initiation:Day pre-surgery
Content: Pre-operation interview
(same as above). Chat (hobbies and
holidays).
Group 3: Interview
N=46(n=46 at one-year follow-up)
Initiation:Day pre-surgery
Content: Pre-operation interview
(same as above).
Cho 2013 [20] Breast cancer (stage II-III) awaiting complete or partial mastectomy
Group 1: Papilla gown and education
N=45(N=15 at six-months follow-up; reasons for loss to follow-up reported)
Initiation:Pre-surgery
Content: Papilla Gown given,
along with instructions on how to wear it.
Education- teaching standard arm exercises (40-minutes personal education sessions)
Group 2: Education
N=46 (N=12 at six-month follow-up; reasons for loss to follow-up reported)
Initiation:One-week pre-surgery
N=46(N=13 at six-months follow-up; reasons for loss to follow-up reported)
Standard hospital gown
One-week and six-months post-surgery
Post-mastectomy activity
Body image Post-mastectomy
gown comfort Breast cancer
knowledge
Six-months post-surgery Lymphedema
High risk of bias
Content: Education (as above)
Group 3: Papilla gown
N=46(N=13 at six-month follow-up; reasons for loss to follow-up reported)
Initiation:Post-surgery
Content: As above
All participants in the treatment groups received a pictorial handbook, Care after Surgery for Breast Cancer.
Garssen 2013 [29] Breast cancer patients (awaiting surgery)
N=42 enrolled(N=34 included in analysis; reasons for losses to follow-up reported)
Definition: Stress Management Training
N=43(N=36 included in analysis; reasons for loss to follow-up reported)
Usual care
Days six and one pre-surgery, days two, five, 30 and 90 post-surgery
Anxiety Depression Quality of life Wellbeing
High risk of bias
Initiation:Five-day prior to surgery
Content: Four sessions (Two
sessions pre-surgery; Two post-surgery- 45-60minutes each) of relaxation and guided imagery techniques and counseling
Delivered by a clinical psychologist.
Perception of control
Fatigue Sleep
disturbances Satisfaction with
intervention
Larson 2000 [27] Breast cancer patients (awaiting surgery)
N=23 enrolled(no losses to follow-up)
Definition:Psychosocial intervention
Initiation:Pre-surgery
Content: Two 90-min
intervention sessions conducted individually or in small groups led by clinical
N=18 enrolled(no losses to follow-up)
Standard care
Post-IV (one to three days prior to surgery) and one-week post-surgery
Depression Impact of events Global optimism Quality of life Immunological
markers
High risk of bias
psychologists. Discussion of the
emotional impact of their diagnosis and impending surgery and educated about stress.
Progressive muscle relaxation and led through an exercise.
Each patient was given a cassette recording of this exercise to practice the exercise twice daily.
Bladder cancerJensen 2014 [24] Invasive muscle or
high risk non-invasive muscle bladder cancer patients scheduled for radical cystectomy
N=65 enrolled(n=47 completed, reasons for loss to follow-up were documented)
Definition:Exercise-based prehabilitation programme
Initiation:14-days pre-surgery
Content:
N=64 enrolled(N=53 available at follow-up; reason for losses to follow-up documented)
Standardised fast track surgery principles
Physical activity Personal ADLs Habitual bowel
function Time to restored
bowel function Pain and nausea Early
complications -less than 90 days post-operation
Death (cause) Readmission
Moderate risk of bias
Standardised fast track surgery principles.
Programme included endurance and strength exercises. A step-trainer was provided.
(Within 30 days)
Multiple cancer sitesPurcell 2011 [15] Cancer patients set
to receive at least 20 days of radiotherapy aged over 18-years old
Group 1: Pre- and Post-Radiotherapy Cancer-related Fatigue Intervention Trial (CAN-FIT)
N=27 enrolled in study(N=21 available at final follow-up, reasons for losses to follow-up reported)
Initiation:One-week prior to radiotherapy
Content: Based on Health Belief
Model. Participant handbook,
goal setting and progress diary.
Session content: what
N=28 enrolled at beginning of study(N=24 available at final follow-up, reasons for follow-up reported)
Face-to-face education delivered by a nurse about the radiotherapy process and patient-specific diagnosis and generic one-page flyer regarding fatigue
Post-radiotherapy and six-weeks post-radiotherapy
Fatigue Quality of life Physical activity Anxiety Depression Sleep
disturbances Employment
Low risk of bias
is radiotherapy and its processes, side effects of treatment including fatigue
Behavioural strategies to combat fatigue
Group 2: Pre-radiotherapy only CAN-FIT
N=28 enrolled in study(N=24 available at final follow-up, reasons for losses to follow-up reported)
Initiation:One to two-weeks pre-radiotherapy
Content: see above
Group 3: Post-radiotherapy only CAN-FIT
N=27 enrolled in study (N=22 available at final follow-up, reasons for losses to
follow-up reported)
Initiation:Post-radiotherapy
Content: see above
ADLs= Activities of Daily Living, CAN-FIT= Cancer Fatigue Intervention Trial, COPD= Chronic Obstructive Pulmonary Disease, IMT= Inspiratory Muscle Training, IV= Intervention, N= number, PFMT= Pelvic Floor Muscle Training, PRP=pulmonary rehabilitation programme, T= Time-point