Patient perceptions of physiotherapy and prehabilitation before hip and knee arthroplasty in South Africa

Background: Hip and knee joint arthroplasty in many low- and middle-income countries has lengthy waiting lists as trauma-related procedures are prioritised. A comprehensive care pathway that includes prehabilitation can enhance patient outcomes. Prior to designing an impactful service, a contextually grounded study with an understanding of current knowledge, relationship between felt and expressed needs in the specific socio-cultural setup is critical. Objectives: This study aimed to investigate patients’ knowledge and perceptions of physiotherapy and prehabilitation before undergoing total hip or knee replacement operations in a South African public healthcare setting. Method: A mixed-methods approach utilising semi-structured, face-to-face interviews and questionnaires was employed. Patients in the orthopaedic outpatient queue who consented to participate were recruited. Forty-nine participants answered the questionnaires, and seven patients were interviewed. Questionnaire data were analysed descriptively, including estimates of means and percentages and qualitative data by content analysis. Results: A significant (p < 0.001) 77.6% (38) of patients indicated that they were unsure of the role of a physiotherapist, and 67.3% (33) of respondents were unsure of the necessity for pre-operative exercises (p < 0.001). Three main themes emerged from the interviews, which were patients’ preconceptions of physiotherapy, the perceived value of prehabilitation and patients’ recommendations regarding physiotherapy and prehabilitation. Conclusion: This study identified a lack of knowledge and understanding regarding physiotherapy and prehabilitation among these patients. Contribution: The findings of this study may inform the design of a prehabilitation programme tailored to this context and highlighted a need for the education of medical personnel.