Background
Methods
Data collection and analysis
Selection of studies
Data extraction and management
Assessment of risk of bias in included studies
Dealing with missing data
Assessment of heterogeneity and sensitivity analyses
Data synthesis and statistical analysis
Results
Reference and country | Sample size | Participant characteristics | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Age | Sex | Condition | Surgery procedure (as reported) | Urinary diversion type | Surgery type | |||||
Total | INT | CONT | INT | CONT | ||||||
Ali et al., 1989 [12] Egypt | 30 | 15 | 15 | Mean 45.33 SD 5.9 | Mean 45.86 SD 4.4 | Male = 23 Female = 7 | Bladder cancer | Urinary diversion | Not reported | Not reported |
Banerjee et al., 2017 [14] UK | 60 | 30 | 30 | Mean 71.60 SD 6.80 | Mean 72.5 SD 8.49 | Male = 53 Female = 7 | Bladder cancer | Radical cystectomy and urinary diversion | Not reported | Any surgical technique |
Choi et al., 2011 [26] Korea | 62 | 30 | 31 | Mean 63.5 SD 4.5 | Mean 64.5 SD 8.8 | Not reported | Bladder cancer | Radical cystectomy and urinary diversion | Ileal conduit Orthotopic neobladder | Open and robot-assisted |
Deibert et al., 2016 [28] USA | 102 | 50 | 52 | Not reported | Not reported | Male = 37 Female = 13 | Bladder cancer | Radical cystectomy and urinary diversion | Ileal conduit Neobladder Pouch | Open and robot-assisted |
Frees et al., 2017 [25] Canada | 23 | 10 | 13 | Mean 65.75 Range 49–86 | Mean 70.40 Range 51–84 | Male = 18 Female = 5 | Bladder cancer | Radical cystectomy and urinary diversion | Ileal conduit Studer neobladder | Open and robot-assisted |
Ghoneim & Hegazy, 2013 [22] Egypt | 60 | 30 | 30 | Mean 50.5 SD 11.2 | Mean 49.4 SD 10.2 | Male = 45 Female = 15 | Bladder cancer | Radical cystectomy and urinary diversion | Not reported | Not reported |
107 | 65 | 64 | Mean 68.5 SD 9.8 | Mean 70.6 SD 9.2 | Male = 79 Female = 28 | Bladder cancer | Radical cystectomy | Ileal conduit Orthotopic neobladder Continent cutaneous reservoir | Open and robot-assisted | |
Karl et al., 2014 [24] Germany | 101 | 62 | 39 | Not reported | Not reported | Not reported | Bladder cancer | Radical cystectomy | Ileal conduit Orthotopic neobladder | Not reported |
Lee et al., 2014 [16] USA | 280 | 143 | 137 | Mean 66 SD 10.9 | Mean 64 SD 9.8 | Male = 223 Female = 57 | Bladder cancer | Radical cystectomy and urinary diversion | Orthotopic neobladder Continent cutaneous reservoir Noncontinent cutaneous reservoir | Open and robot-assisted |
Månsson et al., 1997 [1] Sweden | 57 | 24 | 26 | Not reported | Not reported | Not reported | Bladder cancer | Radical cystectomy | Orthotopic neobladder | Not reported |
Merandy et al., 2017 [15] USA | 8 | 4 | 4 | Median 74.5 IQR 73–81 | Median 72 IQR 62–81.5 | Male = 8 Female = 0 | Bladder cancer | Radical cystectomy and urinary diversion | Orthotopic neobladder Incontinent conduit | Not reported |
Mohamed et al., 2016 [23] Egypt | 60 | 45 (15 per INT group) | 15 | Group 2 Mean 54.53 SD 8.56 | Mean 47.80 SD 7.23 | Male = 48 Female = 12 | Bladder cancer | Radical cystectomy | Not reported | Not reported |
Group 3 Mean 54.20 SD 10.65 | ||||||||||
Group 4 Mean 53.33 SD 10.0 | ||||||||||
Olaru et al., 2015 [17] Romania | 20 | 10 | 10 | Median 62.5 | Median 62.0 | Male = 20 Female = 0 | Bladder cancer | Radical cystectomy and ileal urinary diversion | Orthotopic neobladder Bricker diversion | Not reported |
Porserud et al., 2014 [21] Sweden | 18 | 9 | 9 | Mean 72 SD 5 | Mean 72 SD 4 | Male = 14 Female = 4 | Bladder cancer | Radical cystectomy and urinary diversion | Ileal conduit | Open |
157 | 74 | 83 | Median 67 Range 34–80 | Median 66 Range 30–86 | Male = 106 Female = 51 | Bladder cancer | Radical cystectomy, extended pelvic lymph node dissection, and ileal diversion | Ileal conduit Ileal orthotopic bladder substitute Catheterisable pouch | Not reported |
Participants
Interventions
Intervention type | Author and date | Recruitment and setting | Perioperative stage and delivery | Intervention content | Intervention time, duration, frequency | Length of follow-up |
---|---|---|---|---|---|---|
Exercise therapy | Banerjee et al., 2017 [14] | Patients recruited from a single hospital. Supervised intervention setting. | Preoperative intervention delivered by exercise science staff | Short-term preoperative vigorous intensity aerobic interval exercise on a cycle ergometer using the Borg Ratings of Perceived Exertion (RPE) Scale to control intensity. 5–10 warm up against light resistance (50 W), patients aimed to perform 6 × 5 min intervals to a target perceived exertion of 13–15 (somewhat hard to hard equating to 70–85% predicted max heart rate based on 220-age, with 2.5 min interpolated active rest intervals against light resistance (50 W). Instructed to maintain a steady pedalling cadence of 50–60 rev min-1 during intervals, and the exercise programme was progressed gradually adding more load to the flywheel to maintain the target perceived exertion. Followed by cool down against low resistance (50 W). | 5–10 warm up.6 × 5 min intervals with 2.5 min interpolated active rest intervals. Twice weekly over preoperative period until surgery (3–6 weeks). Minimum of six sessions performed. | Until discharge |
Jensen, Jensen et al., 2014 [18] | Patients recruited from a single hospital. Combined hospital and home-based intervention setting | Pre- and postoperative intervention delivered by physiotherapists | Preoperative standardised exercise training programme at home; step training on a step trainer and muscle strength and endurance exercises. Postoperative mobilisation and rehabilitation; instructions for getting out of bed, mobilisation and walking. Exercise-based rehabilitation in the hospital; respiratory and circulatory exercises, mobilisation, walking, supervised standardised progressive muscle strength and endurance training. Patients discharged with a home training exercise programme. | Preoperative 15 min step training and daily exercise programme consisting of six different exercises with individualised repetitions twice-daily. Postoperative mobilisation and exercise-based rehabilitation for 30 min twice-daily for the first seven postoperative days. | Day 35 and 4 months postoperatively | |
Jensen, Petersen et al., 2015 [20] | ||||||
Jensen, Laustsen et al., 2016 [19] | ||||||
Porserud et al., 2014 [21] | Patients recruited from a single hospital. Combined hospital and home-based intervention setting | Postoperative intervention delivered by physiotherapists | Postoperative group exercise training programme in the hospital; lower body strength and endurance training; walking and strengthening exercises, balance training, mobility training and stretching exercises. Music was used as inspiration. Participants were also instructed to take walks at a self-selected pace. | 45 min twice a week for 12 weeks. Walks at a self-selected pace, 3–5 days a week for at least 15 min. | 14 weeks and 1 year postoperatively | |
Pharmaceutical | Ghoneim & Hegazy 2013 [22] | Recruitment setting not reported. Hospital based intervention | Preoperative intervention. Deliverer not reported | 75 mg pregabalin orally. | 2× day for 10 days prior to operation. | 48 h postoperatively |
Lee et al., 2014 [16] | Patients recruited from multiple centres. Hospital based intervention | Pre- and postoperative intervention. Deliverer not reported | 12 mg alvimopan before surgery and twice-daily doses postoperatively. | Single dose (12 mg) between 30 min and 5 h before surgery and twice-daily doses postoperatively until hospital discharge or a maximum of 7 days (15 in-hospital doses). | Until discharge and 30 days after discharge | |
Mohamed et al., 2016 [23] | Patients recruited from single hospital. Hospital based intervention | Preoperative delivered by staff nurse | Group 2300 mg pregabalin orally 2 h preoperative Group 3300 mg pregabalin orally 2 h preoperative and 12 h thereafter Group 4600 mg pregabalin orally 2 h preoperative | 24 h postoperatively | ||
Fast-track/ERAS protocol | Frees et al., 2017 [25] | Patients recruited from single hospital. Hospital based intervention | Perioperative intervention. Deliverer not reported. | ERAS protocol (see original study for details). | Perioperative until discharge. | 30 days postoperatively |
Karl et al., 2014 [24] | Recruitment setting not reported. Hospital based intervention | Perioperative intervention. Deliverer not reported | ERAS protocol (see original study for details). | Perioperative until discharge. | Day 3, day 7 postoperatively and until discharge | |
Olaru et al., 2015 [17] | Patients recruited from a single hospital. Hospital based intervention | Perioperative intervention delivered by healthcare professionals | ERAS protocol (see original study for details). | Perioperative until discharge. | Until discharge | |
Psychological/educational | Ali et al., 1989 [12] | Patients recruited from a single hospital. Hospital based intervention | Preoperative intervention. Deliverer not reported | Single, preoperative psychoeducational session provided to the patient and a significant other. Included explanation of the surgical procedure, site and appearance of stoma, device to be used postoperatively, reasons for wearing a collection device, and a visit from another “ostomate” who is functioning well. Patients encouraged to express fears and anxieties regarding social aspects of living with a stoma, including clothing, changes in body image, sexuality, exercise, activity, and odour. | 1 × 30–60 min session. | Until discharge (approx. 12 days postoperatively) |
Jensen, Kiesbye et al., 2017 [13] | Patients recruited from a single hospital. Combined hospital and home-based intervention setting | Pre- and postoperative intervention delivered by Urological Enteral Stoma Therapy Nurses | The education programme included basic skills to optimise the ability to perform independent stoma care. Patients encouraged to perform stoma care and change of appliance, both one-piece and two-piece system, at least twice at home providing them with training kits and appliances. The patient was educated about the urostomy and life with a urostomy related to the individual patient’s life and life style. Every patient had a follow up prior to surgery where the Urological Enteral Stoma Therapy Nurse observed self-care skills regarding stoma care and change of appliance. | 1 x education programme under supervision, 2 x practice at home, 1 x self-demonstration under observation prior to surgery. | Day 35 and 4 months and 12 months postoperatively | |
Mansson et al., 1997 [1] | Recruitment setting not reported. Home based intervention | Postoperative intervention. Deliverer not reported | Psychosocial programme including weekly counselling, in the patient’s home for 4 weeks, and thereafter by telephone. The discussion concerned consequences of the operation, practical and emotional problems, influences on mood and relations to partner and friends. The partner could be present at the interview. | Weekly counselling for 4 weeks then via telephone for 2 weeks. | 3 months and 6 months postoperatively | |
Merandy et al., 2017 [15] | Patients recruited from a single hospital. Hospital based intervention | Postoperative day 4, 5 or 6 delivered by trained nurse practitioners | Multimethod educational intervention was developed for each of the three different urinary diversions and included (a) a simplified medical illustration of participant-specific urinary diversion, (b) a step-by-step urinary diversion self-care instructional video, and (c) a pictorial Microsoft PowerPoint®. The content was driven by Bandura’s (1977) four sources of self-efficacy and were based on first-hand observed difficulties experienced by patients with a urinary diversion. The video, PowerPoint, illustrations, and surveys were administered at the bedside by one of the investigators using a tablet computer. The intervention was enhanced by professional demonstration, followed by a chance for return demonstration. | 1 × 1 h in duration, with an optional 30 min for participant questions | Immediately after intervention | |
Chewing gum | Choi et al., 2011 [26] | Patients recruited from a single hospital. Hospital based intervention | Postoperative intervention delivered by study investigators | Sugar-free chewing gum. | 30 min chewing three times daily at 10 am, 3 pm and 8 pm until first flatus. | Discharge. Short term complications within 30 days |
Nutritional | Deibert et al., 2016 [28] | Patients recruited from 2 hospital centres. Hospital based intervention. | Postoperative intervention. Deliverer not reported | Clear liquid diet on postoperative day 1 and access to a full regular diet from postoperative day 2 and beyond. | Postoperative until discharge | 90 days postoperatively |
Roth et al., 2013 [27] | Patients recruited from a single hospital. Hospital based intervention | Postoperative intervention delivered by hospital ward staff | Total parenteral nutrition (TPN). Nutriflex special; a solution with a total energy of 1240 kcal/1000 ml and containing polyamino acids, glucose, and electrolytes. An additional 30 IU Actrapid HM and 1875 IU heparin per 24 h were added to the TPN solution. | Administered continuously for 5 days starting on postoperative day 1. | 1, 3, 7, 12 days postoperatively and complications up to 30 days postoperatively | |
Vidal et al., 2016 [29] | 3, 6, 12, 18, 24, 30 and 36 months postoperatively |
Type
Recruitment and intervention setting
Time, duration and frequency
Measurements
Effect of interventions
Length of stay and readmission
Physiological adjustment after surgery
Psychological adjustment after surgery
Complications
Adherence and fidelity
Paper | Adherence |
---|---|
Ali et al., 1989 [12] | Not reported |
Banerjee et al., 2017 [14] | The median number of supervised exercise sessions attended by patients in the exercise arm was 8 (range 1–10) over a preoperative period of 3–6 weeks. The average number of aerobic intervals achieved in the first week of exercise was 5.5 (range 3.5–6.0), whereas all patients were achieving six intervals per session in the fourth week. |
Choi et al., 2011 [26] | Not reported |
Deibert et al. 2016 [28] | Not reported |
Frees et al., 2017 [25] | Not reported |
Ghoneim & Hegazy, 2013 [22] | 100% adherence to pregabalin |
Jensen et al., 2014 [18] | A total of 66% (95% confidence interval (CI) 51; 78) adhered more than 75% of the recommended progressive standardised exercise program. |
Jensen et al., 2016 [19] | A total of 66% (95% confidence interval (CI) 51; 78) adhered more than 75% of the recommended progressive standardised exercise program. |
Jensen et al., 2015 [20] | A total of 66% (95% confidence interval (CI) 51; 78) adhered more than 75% of the recommended progressive standardised exercise program. |
Jensen et al., 2017 [13] | Not reported |
Karl et al., 2014 [24] | Not reported |
Lee et al., 2014 [16] | 119 out of 143 (83%) patients completed the alvimopan |
Mansson et al., 1997 [1] | Not reported |
Merandy et al., 2017 [15] | Not reported |
Mohamed et al., 2016 [23] | Not reported |
Olaru et al., 2015 [17] | Counselling and education was implemented in 90% of patients |
Porserud et al., 2014 [21] | Participants attended a median of 76% (range 67–95%) of the group exercise training sessions and patients self-reported daily walks on 87% (56–100%) of the days during the 12-week period, averaging 3.5 h (2–11.5%) per week |
Roth et al., 2013 [27] | Not reported |
Vidal et al., 2016 [29] | Not reported |