‘Prehabilitation Should Adapt to the Person, not the Other Way Around’: A Qualitative Study Exploring Stakeholder Perceptions of Prehabilitation for Total Hip and Knee Arthroplasty

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Abstract
Background: Prehabilitation aims to increase functional capacity and physiological reserve prior to surgery, to improve post‐operative outcomes. Despite growing research on prehabilitation for total hip arthroplasty (THA) and total knee arthroplasty (TKA), its acceptability and barriers and enablers to implementation in clinical settings are not well understood. Objective: This study, involving patients and healthcare professionals (HCPs), aimed to explore the acceptability of prehabilitation, identify factors affecting prehabilitation access, uptake and delivery, and investigate perspectives on feasible and preferred care models, and prehabilitation content. Methods: Semi‐structured interviews were conducted with patients who had undergone or were awaiting THA or TKA and HCPs involved in their care at a public hospital in Melbourne, Australia. Interview guides were informed by the Theoretical Framework of Acceptability and the Theoretical Domains Framework. Data were analysed using an inductive‐deductive approach. Results: Thirty interviews were completed with patients ( n = 15) and HCPs ( n = 15). Three major concepts emerged: (1) Understanding and beliefs —while knowledge varied, prehabilitation was generally viewed as acceptable and beneficial; (2) Barriers and enablers —factors influencing uptake and delivery were identified at three levels of care; patient‐level (e.g., mindset), HCP‐level (e.g., confidence discussing prehabilitation with patients), and system‐level (e.g., long surgical waitlists making prehabilitation timing challenging); (3) Strategies for success —both groups emphasised tailored prehabilitation, multi‐modal delivery, and support throughout the surgical pathway as important intervention components. Conclusion: This study identified factors influencing acceptability, uptake, and delivery of prehabilitation at various care levels. The findings will inform the development of a flexible, stakeholder‐informed prehabilitation model to empower and optimise patients prior to THA and TKA.

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