Elizabeth Walkley

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.

Background: Public health waiting lists for elective or planned orthopaedic surgery are increasing to the point where demand far exceeds our ability to treat. This is largely due to ageing populations, rising obesity and the continued impact of delays caused by the COVID-19 pandemic. While waiting, patients suffer debilitating physical pain, functional limitation, social isolation, and associated mental health impacts while some are unable to work. This qualitative scoping review explored and mapped the experiences of patients of waiting for elective or planned orthopaedic surgery. Methods: This review was conducted according to the Joanna Briggs Institute Scoping Review methodology and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A comprehensive database search was conducted to identify English-language articles from 2009 until June 2025. Data extraction was informed by the Standards for Reporting Qualitative Research. Results were thematically analysed and presented using the Quality Health Outcomes Model. Results: The initial search identified 4713 articles, of which 21 manuscripts met inclusion criteria. The 21 articles comprised 17 primary qualitative research studies and four review articles published within the designated time period (2009–2025). Two key themes were identified: (i) patients waiting for elective orthopaedic surgery need psychosocial support and (ii) system-level, multifactorial communication issues with the waiting list leave patients feeling lost between primary and specialist care. These themes suggest that the challenges faced due to lengthy elective surgery waiting lists are not simply a capacity issue, but also a challenge of coordinated, patient- centred care. Conclusion: Waiting for surgery is consistently described by patients as a source of anxiety and distress. With waiting list times for elective surgery increasing, the experience can be improved in part with adequate communication from healthcare providers. A re-focus on what matters most to the patient and their family is required in order to deliver adequate patient-centred care while patients wait for surgery.

Elective lumbar spine surgery is among the more frequently delayed orthopaedic procedures in the Australian public hospital system. The extent to which prolonged preoperative wait time affects the eventual postoperative response remains incompletely characterised. This prospective single-centre cohort study examined six-week postoperative outcomes in 23 patients (mean age 58.0 years; 52.2% male) undergoing elective lumbar spine surgery at an Australian public tertiary orthopaedic unit, with preoperative and postoperative assessments using the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), and the 36-Item Short Form Health Survey (SF-36). Median preoperative wait was 64 days (range 15–288). Paired analyses demonstrated large, statistically and clinically significant improvements across all outcome instruments: composite VAS decreased by 4.4 points (p<0.001), ODI by 20.6 percentage points (p=0.005), and SF-36 component summary scores by 7.4–7.5 T-score points (both p<0.05). At a 2-point VAS minimum clinically important difference threshold, 81% of patients achieved clinically meaningful improvement and none worsened. Longer preoperative wait time was consistently associated with smaller postoperative improvement across VAS (r = -0.43), ODI (r = -0.41), and SF-36 physical component summary (r = -0.39); individual tests did not reach statistical significance, but the consistency of direction and magnitude across three independent instruments suggests a real effect. These findings indicate that surgery delivers substantial benefit in this cohort, and provide hypothesis-generating evidence that prolonged wait time may attenuate that benefit. Confirmation in larger cohorts is required.

The natural history of back pain in patients awaiting elective lumbar spine surgery within a public healthcare system remains incompletely characterised. Understanding how pain evolves over the preoperative waiting period is relevant for resource allocation and the targeting of preoperative interventions. This prospective single-centre cohort study examined back pain trajectories over a six-month waiting period in 40 consecutive patients (mean age 64.7 years; 42.5% male) listed for elective lumbar spine surgery at an Australian public tertiary orthopaedic unit between October 2022 and October 2024. Pain severity was assessed using the Visual Analog Scale across motion, standing, and sitting domains and the 36-Item Short Form Health Survey at recruitment and at six months. Paired analysis demonstrated no statistically or clinically significant change in mean VAS scores across any domain, with mean changes of approximately 0.2 points in all domains and the composite (all p > 0.5). Using a 2-point minimum clinically important difference threshold, 70% of patients (28/40) had no meaningful change, 15% (6/40) improved, and 15% (6/40) worsened. SF-36 results triangulated this finding: no subscale or component summary score showed a statistically significant change over six months. These findings indicate that, contrary to the prevailing assumption, mean preoperative pain remains stable for most patients during a six-month wait, while a minority subgroup deteriorates. The results extend recent international evidence to the Australian public-system context and support a shift toward identifying and targeting patients at risk of meaningful preoperative deterioration rather than universal preoperative interventions.