International consensus on the content of prehabilitation in spine surgery: results of a nominal group technique

BACKGROUND CONTEXT: Spine surgery, like all major surgeries, carries the risk of adverse events and delayed recovery. Prehabilitation programs may mitigate negative prognostic factors to reduce complications and promote faster recovery postoperatively following spine surgery. There is no international consensus or recommendations regarding prehabilitation components in spine surgery. PURPOSE: This study aims to establish international consensus on important modalities of prehabilitation before spine surgery for patients appropriate for prehabilitation using a modified nominal group technique (NGT). STUDY DESIGN/SETTING: A modified NGT. PATIENT SAMPLE: This study used a modified NGT to establish consensus among 50 participants during the International Forum for Back and Neck Pain (ILBP Forum) 2023 and International Society for the Study of the Lumbar Spine (ISSLS) 2024 conference. OUTCOME MEASURES: The rank for each theme and component was computed as the mean of the ranking. We expressed the dispersion in ranking as a measure of consensus. METHODS: During the workshops participants consisting of clinicians and researchers ranked themes and components of a prehabilitation intervention for patients scheduled for spine surgery. The rank for each theme and component was calculated as the mean rank, the dispersion in rankings was used as a measure of consensus. RESULTS: Five main prehabilitation themes were identified and ranked from most to least important by the participants: education (consensus=0.65), psychological prehabilitation (consensus=0.56), physical prehabilitation (consensus=0.37), multidisciplinary prehabilitation (consensus=0.54) and lifestyle factors (consensus=0.53). Within themes, different prehabilitation components were identified and ranked by priority. CONCLUSIONS: The 5 themes identified by this NGT consensus process (education, psychological prehabilitation, physical prehabilitation, multidisciplinary prehabilitation and lifestyle factors) can help inform the design of innovative prehabilitation interventions for optimizing recovery from spine surgery.