Author(s): BARNARD, J., SKINSTAD, D.A., DE VILLIERS, E., VENTER, R., Institution: STELLENBOSCH UNIVERSITY, Country: SOUTH AFRICA, Abstract-ID: 1865

INTRODUCTION:
Orthopaedic care predominantly emphasizes postoperative rehabilitation, with limited attention to pre-operative exercise interventions (prehabilitation). Emerging evidence indicates that prehabilitation may enhance surgical outcomes and health-related quality of life in individuals with musculoskeletal conditions. Biokinetics, a South African exercise-based health profession, applies therapeutic exercise in managing chronic disease and musculoskeletal impairments, positioning biokineticists to contribute meaningfully to multidisciplinary orthopaedic prehabilitation. Referral patterns may reflect medical practitioners’ perceptions of prehabilitation and the role of biokineticists, which likely influence referral behaviors and pre-operative service delivery. Understanding these perceptions is essential to identifying barriers and facilitators to integrating prehabilitation into orthopaedic care pathways.
METHODS:
A basic qualitative research design was employed to explore and interpret health care practitioners’ perceptions of prehabilitation as a treatment modality for patients with musculoskeletal conditions. Consistent with Merriam and Tisdell’s (2016) approach to basic qualitative inquiry, the study sought to understand how participants make meaning of prehabilitation within their professional practice contexts. A purposive sampling strategy was used to recruit information-rich participants, comprising two professional groups within the orthopaedic referral network: orthopaedic surgeons and biokineticists (n = 16). Maximum variation sampling was applied to capture a range of perspectives across professional roles and practice settings. Data were collected through semi-structured, in-depth interviews, allowing for flexibility while maintaining alignment with the research questions. Interviews were audio-recorded, transcribed verbatim, and analyzed using an iterative and systematic thematic analysis process. Data collection and analysis occurred concurrently, enabling constant comparison and refinement of emerging themes. Trustworthiness was enhanced through prolonged engagement with the data, reflexive memo-writing, and an audit trail documenting analytic decisions.
RESULTS:
Preliminary thematic analysis indicates divergent perceptions of prehabilitation among health care practitioners. Orthopaedic surgeons tended not to consider prehabilitation as an adjunct to surgical preparation, whereas biokineticists emphasized its preventive and proactive role in orthopaedic care. Findings further suggest that referral for prehabilitation lacks a formalized process and is largely influenced by individual surgeon preference and established professional relationships. Time constraints, perceived patient readiness, cost considerations (specifically medical aid benefits), and entrenched rehabilitation-focused care pathways emerged as key barriers to prehabilitation referral.
CONCLUSION:
Findings indicate that inconsistent professional perceptions and informal referral practices contribute to the underutilization of prehabilitation in orthopaedic care. Structural and contextual barriers (time constraints, cost considerations, perceived patient readiness, and entrenched rehabilitation-focused models) influence implementation. Addressing interprofessional dialogue and developing clearer referral frameworks may facilitate more effective integration of prehabilitation within orthopaedic treatment pathways.