Principles and practice of presurgical rehabilitation in the community.

Abstract

Introduction: Preoperative rehabilitation is an essential component of joint replacement surgery preparation, aiming to improve patient outcomes and reduce postoperative complications. A study conducted in Boston demonstrated that patients undergoing a six-week prehabilitation program—including aquatic and land-based strength training, aerobic, and flexibility exercises—reduced their need for inpatient rehabilitation by 73%. Patients awaiting surgery often experience pain, joint stiffness, muscle weakness, balance problems, and psychological concerns. Prehabilitation addresses these issues by focusing on six key areas: strength, range of motion, joint stability, flexibility, balance, and cardiovascular fitness. Additionally, patients are trained to use assistive devices and adapt to postoperative mobility restrictions. A structured prehabilitation program typically includes a multidisciplinary approach involving physiotherapists, occupational therapists, and social workers. Patients undergo motor and functional assessments, receive personalized treatment plans, and participate in a two-week group training program, supplemented with individual sessions as needed. This preparation enhances physical and functional readiness while also providing psychological support. Results Postoperative rehabilitation begins immediately after surgery and aims to facilitate pain management, wound care, functional independence, and mobility restoration. A study of 29 patients (mean age 72±10 years) undergoing total knee or hip replacement showed that after an average hospital stay of 5.7±2.0 days, home-based rehabilitation commenced within 2.0±1.5 days and lasted 32.7±8.2 days. Patients received physiotherapy (11.4±3.8 sessions), nursing care (1-2 visits), and occasional occupational therapy and social work support. Functional assessments demonstrated significant improvements, with Functional Independence Measure (FIM) scores increasing from 103.0±5.3 to 117.7±5.5 and Timed Up and Go (TUAG) test times reducing from 54.4±19.1 seconds to 28.7±14.0 seconds, indicating enhanced mobility and independence. A follow-up study of 38 patients (mean age 73±12 years) undergoing total knee replacement, total hip replacement, or hip fracture surgery confirmed the prolonged benefits of home-based rehabilitation. Patients participated in a 34.0±9.4-day program, receiving physiotherapy (12.4±5.2 sessions), nursing care (1.9±0.7 visits), and occupational therapy as needed. A post-discharge telephone survey conducted approximately 114.5±51.4 days later revealed high patient satisfaction (8.8±2.0 on a 10-point scale), well-preserved walking ability (4.7±1.2 on a 6-point scale), and moderate success in stair climbing (3.0±0.9 on a 4-point scale). Most patients reported partial preservation of their preoperative motor abilities (1.9±0.8 on a 3-point scale). Conclusions These findings highlight the effectiveness of structured pre- and postoperative rehabilitation in improving functional outcomes, promoting independence, and reducing the need for prolonged inpatient care. Home-based rehabilitation programs, in particular, demonstrate prolonged benefits, reinforcing the importance of integrating prehabilitation into the standard care pathway for joint replacement patients.