Exploring feasibility of health-related quality of life assessments and pain diaries in patients undergoing prehabilitation before total knee arthroplasty: a pilot study

Abstract Background Prehabilitation prior to total knee arthroplasty (TKA) may mitigate deterioration in health-related quality of life (HRQOL) during the preoperative period and support recovery after surgery. However, little is known about the feasibility of systematically monitoring HRQOL and pain through patient-reported outcome measures (PROMs) in this context. This pilot study aimed to evaluate the feasibility of using validated HRQOL questionnaires and daily pain diaries during a prehabilitation programme for patients awaiting (TKA) and up to 12 weeks postoperatively. Methods Twenty patients (mean age 73 ± 6 years) scheduled for primary unilateral TKA were randomly assigned to an intervention group (IG) or control group (CG). The IG participated in a 4- to 8-week individualised prehabilitation programme involving exercise and education. Feasibility was assessed through the completion rates of daily pain diaries and three HRQOL questionnaires (EQ-5D-5 L, SF-12 and KOOS KRQOL) collected at baseline, preoperatively, and at 6- and 12-weeks postoperatively. Results HRQOL questionnaires demonstrated high completion rates across both groups (90%). In contrast, adherence to paper-based pain diaries was suboptimal and notably low (CG: 58%; IG: 47%), falling below the threshold for meaningful analysis. Consequently, pain trajectory over time could not be reliably assessed. No significant group-by-time interaction effects were observed for any HRQOL measure: EQ-5D-5 L (p = 0.67; F = 0.51), KOOS KRQOL (p = 0.72; F = 0.64), SF-12 PCS (p = 0.06; F = 0.50) and MCS (p = 0.36; F = 0.10). Conclusion This pilot study confirms the feasibility and acceptability of HRQOL questionnaires in older patients undergoing prehabilitation before TKA. However, the low diary completion rates highlight the need for alternative pain-monitoring-approaches – such as electronic formats - to improve data quality in future trials. Preliminary findings suggest potential benefits of prehabilitation, warranting further investigation in larger studies. Trial registration ClinicalTrials.gov Identifier; NCT05314985. Registered 20 July 2021. BASEC-Nr. 2020–03060.